Provider Demographics
NPI:1568473700
Name:HURST, STEPHEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:HURST
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0032
Mailing Address - Country:US
Mailing Address - Phone:224-318-0118
Mailing Address - Fax:847-919-4615
Practice Address - Street 1:1264 SAINT NICHOLAS AVE STE B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7263
Practice Address - Country:US
Practice Address - Phone:718-280-4188
Practice Address - Fax:224-235-4652
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1822392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01441029Medicaid
NJ7425601Medicaid
NY01441029Medicaid
NJ7425601Medicaid
NJ002404Medicare PIN