Provider Demographics
NPI:1144227737
Name:BOAS, STEVEN RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:BOAS
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 1:191 WAUKEGAN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2743
Mailing Address - Country:US
Mailing Address - Phone:847-998-3434
Mailing Address - Fax:847-998-8584
Practice Address - Street 1:2401 RAVINE WAY
Practice Address - Street 2:STE 302
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7645
Practice Address - Country:US
Practice Address - Phone:847-998-3434
Practice Address - Fax:847-998-8584
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36091411Medicaid
IL36091411Medicaid
F60356Medicare UPIN