Provider Demographics
NPI:1508932856
Name:LATHROP, STEPHEN M (CPED)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:LATHROP
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-2837
Mailing Address - Country:US
Mailing Address - Phone:618-544-9220
Mailing Address - Fax:
Practice Address - Street 1:1106 N ALLEN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1116
Practice Address - Country:US
Practice Address - Phone:618-544-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0666920001Medicare NSC