Provider Demographics
NPI:1316003833
Name:STEIN, ADAM DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVID
Last Name:STEIN
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 1:7 BLANCHARD CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2039
Mailing Address - Country:US
Mailing Address - Phone:630-208-6775
Mailing Address - Fax:630-260-0670
Practice Address - Street 1:7 BLANCHARD CIR STE 202
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2039
Practice Address - Country:US
Practice Address - Phone:630-208-6775
Practice Address - Fax:630-260-0670
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187109207R00000X
IL036-126614207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-126614Medicaid
IL04515143OtherBCBS#
IL390362031Medicare PIN
IL0727500001Medicare NSC
IL390361032Medicare PIN