Provider Demographics
NPI:1225071152
Name:HERMES, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:HERMES
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 1:400 S KENNEDY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2682
Mailing Address - Country:US
Mailing Address - Phone:815-933-0007
Mailing Address - Fax:815-933-2776
Practice Address - Street 1:400 S KENNEDY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2682
Practice Address - Country:US
Practice Address - Phone:815-933-0007
Practice Address - Fax:815-933-2776
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056725207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL791113742OtherRAILROAD MEDICARE
IL174184OtherFEDERAL BLACK LUNG
IL4600191OtherBLUE CROSS/BLUE SHIELD
IL036056725Medicaid
IL5043293OtherAETNA
IL036056725Medicaid
IL791113742Medicare Oscar/Certification