Provider Demographics
NPI:1265447841
Name:DULAK, STEVE (MPT)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:DULAK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 N RIVERSIDE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5908
Mailing Address - Country:US
Mailing Address - Phone:847-244-8420
Mailing Address - Fax:847-249-4338
Practice Address - Street 1:495 N RIVERSIDE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5908
Practice Address - Country:US
Practice Address - Phone:847-244-8420
Practice Address - Fax:847-249-4338
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932440OtherBCBS PROVIDER ID
IL211934Medicare ID - Type UnspecifiedGROUP NUMBER
IL04932440OtherBCBS PROVIDER ID