Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 336-046201 | IL |
N | 2080P0214X | Pediatric Pulmonologist | 336-046201 | IL |
NPI | 1285619726 |
---|---|
Provider Name | Dr. Steven O Lestrud |
First Address | Kenilworth, IL 60043-1036 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 23/04/2018 |