Provider Demographics
NPI:1255597944
Name:WIELGUS, STEPHEN JAMES (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:WIELGUS
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 1:920 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3839
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:224-251-4568
Practice Address - Street 1:920 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:224-251-4568
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126677207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine