Individual
STEPHEN H JENNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 E MASON ST, SUITE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Mailing address
PO BOX 19420, SPRINGFIELD, IL 62794-9420
(217) 788-0706
(217) 525-2535
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036-091807
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060031123
RAILROAD
IL
Enumeration date
10/18/2006
Last updated
06/02/2008
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