Provider Demographics
NPI:1639602907
Name:STEPNOSKI, NICHOLAS DANIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DANIEL
Last Name:STEPNOSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1367
Mailing Address - Country:US
Mailing Address - Phone:219-789-5717
Mailing Address - Fax:
Practice Address - Street 1:10760 W 143RD ST STE 60
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1920
Practice Address - Country:US
Practice Address - Phone:708-301-5600
Practice Address - Fax:708-301-5602
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005905213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist