Provider Demographics
NPI:1013909134
Name:CARTER, STEPHEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:CARTER
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 1:2148 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4562
Mailing Address - Country:US
Mailing Address - Phone:773-938-8128
Mailing Address - Fax:773-983-8126
Practice Address - Street 1:2148 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4562
Practice Address - Country:US
Practice Address - Phone:773-938-8128
Practice Address - Fax:773-938-8126
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113222207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00232723OtherRAILROAD MEDICARE
ILK17271Medicare PIN
ILK17272Medicare PIN
ILP00232723OtherRAILROAD MEDICARE