Provider Demographics
NPI:1467438630
Name:DEANGELES, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:DEANGELES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2402
Mailing Address - Country:US
Mailing Address - Phone:312-922-2500
Mailing Address - Fax:312-922-2520
Practice Address - Street 1:200 S MICHIGAN AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2402
Practice Address - Country:US
Practice Address - Phone:312-922-2500
Practice Address - Fax:312-922-2523
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036082732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082732Medicaid
F19585Medicare UPIN