Provider Demographics
NPI:1285645804
Name:DAMORE, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:DAMORE
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 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-366-5180
Mailing Address - Fax:217-366-6106
Practice Address - Street 1:109 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3909
Practice Address - Country:US
Practice Address - Phone:217-366-5180
Practice Address - Fax:217-366-6106
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361393862085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA55663OtherLICENSE
CA00A556630Medicaid
CA00A556630Medicaid
CAA55663OtherLICENSE
A55663Medicare UPIN
CA00A556630Medicaid