Provider Demographics
NPI:1427331891
Name:STEPHEN T ANG MD SC
Entity type:Organization
Organization Name:STEPHEN T ANG MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-532-1688
Mailing Address - Street 1:1054 MARTIN LUTHER KING DR
Mailing Address - Street 2:STE 120
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3000
Mailing Address - Country:US
Mailing Address - Phone:618-532-1688
Mailing Address - Fax:618-436-8081
Practice Address - Street 1:1054 MARTIN LUTHER KING DR
Practice Address - Street 2:STE 120
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3000
Practice Address - Country:US
Practice Address - Phone:618-532-1688
Practice Address - Fax:618-436-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088477Medicaid