Provider Demographics
NPI:1700094364
Name:GREENFIELD, NEAL STEFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:STEFAN
Last Name:GREENFIELD
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 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4700
Mailing Address - Fax:630-933-4427
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4700
Practice Address - Fax:630-933-4427
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242708207R00000X
WAMD 60002695207R00000X
ORMD28328207R00000X
IL036122989207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01097051OtherRR MEDICARE PTAN (INDIVIDUAL)
IL206147127OtherMEDICARE PTAN (INDIVIDUAL)
ILCA4748OtherRR MEDICARE PTAN (GROUP)
IL206147OtherMEDICARE PTAN (GROUP)
IL036122989Medicaid