Individual
MR. DOUGLAS S STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12701 W 143RD ST, SUITE 200, HOMER GLEN, IL 60491-7715
(877) 694-7722
(815) 531-0055
Mailing address
12701 W 143RD ST, SUITE 200, HOMER GLEN, IL 60491-7715
(877) 694-7722
(815) 531-0055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085001302
IL
363A00000X
Physician Assistant
Primary
IL085-001302
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085001302
STATE LICENSE NUMBER
IL
Enumeration date
01/16/2006
Last updated
11/07/2016
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