Individual
STEPHEN HOLTSFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 S 5TH ST STE 10, SAINT CHARLES, IL 60174-2700
(630) 940-2468
Mailing address
PO BOX 9030, WHEELING, IL 60090-9030
(847) 495-1617
(847) 537-4866
Taxonomy
Speciality
Code
Description
License number
State
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
036091535
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091535 5
—
IL
01
—
451530938
BLUE SHIELD
IL
01
—
930061957
RAILROAD MEDICARE
IL
Enumeration date
10/24/2006
Last updated
02/23/2024
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