Provider Demographics
NPI:1457311524
Name:SORENSON, STEPHEN CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CARL
Last Name:SORENSON
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 1:1670 CAPITAL ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-7837
Mailing Address - Country:US
Mailing Address - Phone:847-468-9900
Mailing Address - Fax:847-468-9901
Practice Address - Street 1:795 ELA RD STE 115
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-550-4984
Practice Address - Fax:847-847-7289
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092571202K00000X
IL036092571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622308OtherBXBS
E58875Medicare UPIN
ILIL5265001Medicare PIN