Provider Demographics
NPI:1386663631
Name:MANDREA, STEVEN N (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:N
Last Name:MANDREA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7300 W COLLEGE DR
Mailing Address - Street 2:STE 1NW
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1152
Mailing Address - Country:US
Mailing Address - Phone:708-671-1374
Mailing Address - Fax:708-671-1378
Practice Address - Street 1:1420 RENAISSANCE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1330
Practice Address - Country:US
Practice Address - Phone:847-298-1831
Practice Address - Fax:847-298-1832
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036111710207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111710OtherMEDICAL LICENSE
ILIL2485005Medicare PIN