Provider Demographics
NPI:1265419188
Name:RAY, STEPHEN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:RAY
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 1:2520 ELISHA AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099
Mailing Address - Country:US
Mailing Address - Phone:847-872-4561
Mailing Address - Fax:847-872-6419
Practice Address - Street 1:2361 PAYSPHERE CIR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60674
Practice Address - Country:US
Practice Address - Phone:847-746-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL036.1100652086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILB72414Medicare UPIN
ILK02378Medicare ID - Type UnspecifiedMEDICARE #