Provider Demographics
NPI:1073591533
Name:DREZNIN, STEPHEN ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROSS
Last Name:DREZNIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE A102
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8436
Mailing Address - Country:US
Mailing Address - Phone:815-759-4323
Mailing Address - Fax:
Practice Address - Street 1:2338 IMMOKALEE RD # 186
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1445
Practice Address - Country:US
Practice Address - Phone:239-330-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168449-1207RN0300X
IL036132060208M00000X
FLME147800208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132060OtherSTATE LICENSE
NY390006590OtherRAILROAD MEDICARE
NY01420240Medicaid
NY54H371Medicare PIN
NYE59161Medicare UPIN