Individual
MR. GREGORY BROMMETT STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4320 FIR ST, SUITE 210, EAST CHICAGO, IN 46312-3052
(219) 836-5464
(219) 228-4777
Mailing address
6852 S OGLESBY AVE, #2, CHICAGO, IL 60649-1324
(773) 363-6985
(773) 363-6985
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-000611
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200153400
INDIANA WELFARE
IN
Enumeration date
05/09/2007
Last updated
04/25/2008
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