Basic Information
| Provider Information | |||||||||
| NPI: | 1700094364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENFIELD | ||||||||
| FirstName: | NEAL | ||||||||
| MiddleName: | STEFAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 N WINFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601901295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309334700 | ||||||||
| FaxNumber: | 6309334427 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 N WINFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601901295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309334700 | ||||||||
| FaxNumber: | 6309334427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101242708 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD 60002695 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD28328 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 036122989 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01097051 | 01 | IL | RR MEDICARE PTAN (INDIVIDUAL) | OTHER | 206147127 | 01 | IL | MEDICARE PTAN (INDIVIDUAL) | OTHER | CA4748 | 01 | IL | RR MEDICARE PTAN (GROUP) | OTHER | 206147 | 01 | IL | MEDICARE PTAN (GROUP) | OTHER | 036122989 | 05 | IL | MEDICAID |