Basic Information
| Provider Information | |||||||||
| NPI: | 1760448096 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STRYKER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 W 79TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604591784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738844523 | ||||||||
| FaxNumber: | 7738844580 | ||||||||
| Practice Location | |||||||||
| Address1: | 676 N SAINT CLAIR ST | ||||||||
| Address2: | SUITE 1525 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129435427 | ||||||||
| FaxNumber: | 3122660478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 10/01/2013 | ||||||||
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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 | 208C00000X | 208C00000X | IL | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 160005023 | 01 | IL | RAILROAD MEDICARE | OTHER | 036058963 | 05 | IL | MEDICAID | 0001621690 | 01 | IL | BLUE SHIELD | OTHER |