Provider Demographics
NPI:1114056140
Name:CARY, STEPHEN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:CARY
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 1:815 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1080
Mailing Address - Country:US
Mailing Address - Phone:309-672-4984
Mailing Address - Fax:309-672-4790
Practice Address - Street 1:815 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1080
Practice Address - Country:US
Practice Address - Phone:309-672-4984
Practice Address - Fax:309-672-4790
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45151-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34360100Medicaid
WI014902120Medicare ID - Type Unspecified
WI34360100Medicaid