Provider Demographics
NPI:1962529693
Name:VANKLOMPENBURG, STEVEN M (CLINIC MANAGER)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:VANKLOMPENBURG
Suffix:
Gender:M
Credentials:CLINIC MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3929
Mailing Address - Country:US
Mailing Address - Phone:773-243-6000
Mailing Address - Fax:
Practice Address - Street 1:225 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4304
Practice Address - Country:US
Practice Address - Phone:847-941-7556
Practice Address - Fax:847-941-7555
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70013584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist