Provider Demographics
NPI:1275531121
Name:SPONTAK, STEPHEN F (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:SPONTAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9944 S ROBERTS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1555
Mailing Address - Country:US
Mailing Address - Phone:708-233-8709
Mailing Address - Fax:708-599-1552
Practice Address - Street 1:12251 S 80TH AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1256
Practice Address - Country:US
Practice Address - Phone:708-923-5800
Practice Address - Fax:708-923-8324
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083497A207P00000X
IL036086148207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086148Medicaid
IL036086148Medicaid
930016496Medicare PIN
ILL24104Medicare PIN
IL762690Medicare PIN