Individual
DR. MICHAEL WAYNE STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-5243
(093) 655-2000
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 655-4746
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125068180
IL
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
036.163090
IL
2080P0203X
Pediatric Critical Care Medicine Physician
4301501740
MI
Other
Enumeration date
04/04/2016
Last updated
07/05/2023
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