Provider Demographics
NPI:1376872721
Name:HAWTHORNE, STEPHEN ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ELLIOT
Last Name:HAWTHORNE
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 1:1218 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3813
Mailing Address - Country:US
Mailing Address - Phone:630-777-4081
Mailing Address - Fax:
Practice Address - Street 1:501 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5501
Practice Address - Country:US
Practice Address - Phone:630-752-5571
Practice Address - Fax:630-752-5575
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.073273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine