Provider Demographics
NPI:1518129766
Name:NASH, STEVEN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PATRICK
Last Name:NASH
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 1:636 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9789
Mailing Address - Country:US
Mailing Address - Phone:630-355-5302
Mailing Address - Fax:630-778-6088
Practice Address - Street 1:636 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9789
Practice Address - Country:US
Practice Address - Phone:630-355-5302
Practice Address - Fax:630-778-6088
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122247207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0222075OtherBLUE CROSS GROUP NUMBER
IL3631498336019001OtherHFS GROUP PAYEE ID
IL036122247Medicaid
IL1033149844OtherCDPG GROUP NPI
IL363149833OtherCDPG TAX IDENTIFICAITON NUMBER
IL482450OtherMEDICARE GROUP PTAN
IL036122247Medicaid