Provider Demographics
NPI:1144413584
Name:BOPPART, STEPHEN ALLEN (MD/PHD)
Entity Type:Individual
Prefix:PROF
First Name:STEPHEN
Middle Name:ALLEN
Last Name:BOPPART
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:MILLS BREAST CANCER INSTITUTE
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-326-0283
Mailing Address - Fax:217-326-0285
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:MILLS BREAST CANCER INSTITUTE
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-326-0283
Practice Address - Fax:217-326-0285
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36111430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine