Provider Demographics
NPI:1629362223
Name:CHIU, STEPHEN C (DO)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:CHIU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3231 EUCLID AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3471
Mailing Address - Country:US
Mailing Address - Phone:708-783-2000
Mailing Address - Fax:708-783-3656
Practice Address - Street 1:3860 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2460
Practice Address - Country:US
Practice Address - Phone:872-588-3000
Practice Address - Fax:872-588-3001
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133617207Q00000X
IL036-133617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036133617OtherSTATE LICENSE
IL1080328358OtherSPECIALTY BOARD
IL336094852OtherCS LICENSE
IL336094852OtherCS LICENSE