Provider Demographics
NPI:1962416321
Name:RIVARD, STEPHEN PAUL (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PAUL
Last Name:RIVARD
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 1:22285 N. PEPPER RD.
Mailing Address - Street 2:BLDG 100, SUITE 105 ILLINOIS VEIN SPECIALISTS
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2539
Mailing Address - Country:US
Mailing Address - Phone:847-277-9100
Mailing Address - Fax:847-277-9110
Practice Address - Street 1:22285 N. PEPPER RD.
Practice Address - Street 2:BLDG 100, SUITE 105 ILLINOIS VEIN SPECIALISTS
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2539
Practice Address - Country:US
Practice Address - Phone:847-277-9100
Practice Address - Fax:847-277-9110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064684207PE0004X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064684Medicaid
930009892OtherMEDICARE RR
930009892OtherMEDICARE RR
ILC43086Medicare UPIN
C43086Medicare UPIN