Provider Demographics
NPI:1790704435
Name:STEFFEN, SAMUEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:E
Last Name:STEFFEN
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 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3981
Mailing Address - Country:US
Mailing Address - Phone:309-365-8608
Mailing Address - Fax:309-365-8149
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:IL
Practice Address - Zip Code:61753-1327
Practice Address - Country:US
Practice Address - Phone:309-365-8608
Practice Address - Fax:309-365-8149
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109967Medicaid
10220308OtherBLUE CROSS BLUE SHIELD
5720935OtherBLUE CROSS BLUE SHIELD
IL748943Medicare ID - Type UnspecifiedMEDICARE GROUP
5720935OtherBLUE CROSS BLUE SHIELD
K06250Medicare ID - Type Unspecified
10220308OtherBLUE CROSS BLUE SHIELD