Provider Demographics
NPI:1114047115
Name:EPNER, STEPHEN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SCOTT
Last Name:EPNER
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 1:1051 ESSINGTON RD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431
Mailing Address - Country:US
Mailing Address - Phone:815-744-0808
Mailing Address - Fax:
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-744-0808
Practice Address - Fax:815-744-7748
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-072792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C44226Medicare UPIN