Provider Demographics
NPI:1821209610
Name:STEPHEN RIVERA LTD
Entity Type:Organization
Organization Name:STEPHEN RIVERA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-286-7318
Mailing Address - Street 1:5 MIDDLETREE LN
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8993
Mailing Address - Country:US
Mailing Address - Phone:224-286-7318
Mailing Address - Fax:847-381-0301
Practice Address - Street 1:5 MIDDLETREE LN
Practice Address - Street 2:
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-8993
Practice Address - Country:US
Practice Address - Phone:224-286-7318
Practice Address - Fax:847-381-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL301090Medicare PIN