Provider Demographics
NPI:1467013540
Name:SAGE, STEPHANIE HOLMES (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:HOLMES
Last Name:SAGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2101 W RACE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1513
Mailing Address - Country:US
Mailing Address - Phone:312-933-3574
Mailing Address - Fax:
Practice Address - Street 1:1306 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-2703
Practice Address - Country:US
Practice Address - Phone:630-810-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.074903390200000X
IL036.160616208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program