Provider Demographics
NPI:1659802908
Name:STEVENS, ANJELI (DO)
Entity Type:Individual
Prefix:DR
First Name:ANJELI
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANJELI
Other - Middle Name:
Other - Last Name:RAHEJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1800 N KNOXVILLE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3005
Mailing Address - Country:US
Mailing Address - Phone:309-624-9680
Mailing Address - Fax:
Practice Address - Street 1:1800 N KNOXVILLE AVE STE C
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3005
Practice Address - Country:US
Practice Address - Phone:309-624-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1659802908208000000X
MI5101025532208000000X
IL036165816208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics