Provider Demographics
NPI:1407903024
Name:EVERT M VANDERSTOEP,MD LTD
Entity Type:Organization
Organization Name:EVERT M VANDERSTOEP,MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDERSTOEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-856-0070
Mailing Address - Street 1:151 N MICHIGAN AVE
Mailing Address - Street 2:STE 814
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7506
Mailing Address - Country:US
Mailing Address - Phone:312-856-0070
Mailing Address - Fax:312-856-0070
Practice Address - Street 1:151 N MICHIGAN AVE
Practice Address - Street 2:STE 814
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7506
Practice Address - Country:US
Practice Address - Phone:312-856-0070
Practice Address - Fax:312-856-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF85705Medicare UPIN
275560Medicare ID - Type Unspecified