Provider Demographics
NPI:1275561557
Name:EIDT, STEVEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:EIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-736-1717
Mailing Address - Fax:773-736-7538
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-736-1717
Practice Address - Fax:773-736-7538
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-108999207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108999Medicaid
ILK00524Medicare ID - Type Unspecified
IL036108999Medicaid