Provider Demographics
NPI:1578527735
Name:KASHIAN, STEPHEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:KASHIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4905 OLD ORCHARD CTR
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1425
Mailing Address - Country:US
Mailing Address - Phone:847-679-6707
Mailing Address - Fax:847-679-6721
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-679-6707
Practice Address - Fax:847-679-6721
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036066428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601517OtherBLUE CROSS BLUE SHIELD
IL742690Medicare PIN
ILD10153Medicare UPIN