Provider Demographics
NPI:1386692671
Name:GLADDIN, STEPHEN F (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:GLADDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N RANDALL RD STE 310
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2304
Mailing Address - Country:US
Mailing Address - Phone:312-543-8724
Mailing Address - Fax:
Practice Address - Street 1:1435 N RANDALL RD STE 310
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2304
Practice Address - Country:US
Practice Address - Phone:312-543-8724
Practice Address - Fax:847-841-8171
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089120207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089120Medicaid
06123693OtherBCBS
ILK27171Medicare PIN
IL036089120Medicaid