Provider Demographics
NPI:1538405931
Name:SOLUM, STEPHEN M (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:SOLUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4300 COMMERCE CT
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3698
Mailing Address - Country:US
Mailing Address - Phone:630-968-1881
Mailing Address - Fax:630-968-1719
Practice Address - Street 1:1900 OGDEN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4273
Practice Address - Country:US
Practice Address - Phone:630-968-1881
Practice Address - Fax:630-968-1719
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085004570363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL970023229OtherRAILROAD MEDICARE
IL085004570Medicaid
IL085004570Medicaid