Provider Demographics
NPI:1831456755
Name:LEMUS, STEPHANIE N (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:LEMUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W HUBBARD ST
Mailing Address - Street 2:SUITE 3110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5742
Mailing Address - Country:US
Mailing Address - Phone:646-260-6443
Mailing Address - Fax:
Practice Address - Street 1:360 W HUBBARD ST
Practice Address - Street 2:SUITE 3110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5742
Practice Address - Country:US
Practice Address - Phone:646-260-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016743363A00000X
IL085004318363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03762278Medicaid
NYJ400118778Medicare PIN
NYJ400118788Medicare PIN
NY03762278Medicaid