Individual
STEPHEN R AMESBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
675 W NORTH AVE, SUITE 214, MELROSE PARK, IL 60160-1634
(708) 450-4557
(708) 338-0200
Mailing address
7607 MADISON ST, FOREST PARK, IL 60130-3513
(708) 450-4557
(708) 338-0200
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036080212
IL
207RP1001X
Pulmonary Disease Physician
Primary
036080212
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036080212
—
IL
01
—
31601838
BCBS
IL
Enumeration date
10/24/2005
Last updated
02/18/2014
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