Individual
DR. STEPHEN P RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 MIDDLETREE LANE, HAWTHORN WOODS, IL 60047
(224) 286-7318
(847) 381-0301
Mailing address
5 MIDDLETREE LN, HAWTHORN WOODS, IL 60047-8993
(224) 286-7318
(847) 381-0301
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036089771
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001620065
BCBS
IL
05
—
036089771
—
IL
01
—
260050348
PALMETTO GBA
IL
Enumeration date
03/26/2007
Last updated
09/15/2014
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