Provider Demographics
NPI:1114947124
Name:SPRAGUE, STUART M (DO)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:M
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CENTRAL ST STE 800
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1780
Mailing Address - Country:US
Mailing Address - Phone:847-570-2512
Mailing Address - Fax:847-570-1696
Practice Address - Street 1:1000 CENTRAL ST STE 800
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1780
Practice Address - Country:US
Practice Address - Phone:847-570-2512
Practice Address - Fax:847-570-1696
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066785207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E32174Medicare UPIN