Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036-105420 | IL |
NPI | 1093795924 |
---|---|
Provider Name | Dr. Stephen E. Chester |
First Address | Palos Hills, IL 60465-1555 |
Second Address | Palos Heights, IL 60463-1256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036105420 | (05) | IL |
H51981 | (02) | IL |