Provider Demographics
NPI:1265537401
Name:DEVRIES, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:DEVRIES
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 1:675 NORTH ST. CLAIR STREET, SUITE 19-100
Mailing Address - Street 2:BLUHM CARDIOVASCULAR INSTITUTE OF NORTHWESTERN
Mailing Address - City:CHICAGO, IL
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-695-4965
Mailing Address - Fax:312-695-5774
Practice Address - Street 1:675 NORTH ST. CLAIR STREET, SUITE 19-100
Practice Address - Street 2:BLUHM CARDIOVASCULAR INSTITUTE OF NORTHWESTERN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-4965
Practice Address - Fax:312-695-5774
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077377207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E12340Medicare UPIN
P13686Medicare ID - Type Unspecified