Basic Information
| Provider Information | |||||||||
| NPI: | 1790704435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEFFEN | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618203981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093658608 | ||||||||
| FaxNumber: | 3093658149 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617531327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093658608 | ||||||||
| FaxNumber: | 3093658149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036109967 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036109967 | 05 | IL | MEDICAID | 10220308 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 5720935 | 01 | BLUE CROSS BLUE SHIELD | OTHER |