Provider Demographics
NPI:1427030451
Name:SPROUL, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:SPROUL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:431 LAKEVIEW CT SUITE D
Mailing Address - Street 2:METRODOCS
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-296-3040
Mailing Address - Fax:847-296-5546
Practice Address - Street 1:431 LAKEVIEW CT SUITE D
Practice Address - Street 2:METRODOCS
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-296-3040
Practice Address - Fax:847-296-5546
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-02-15
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Provider Licenses
StateLicense IDTaxonomies
IL036066341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16267Medicare UPIN