Provider Demographics
NPI:1144225319
Name:SANOFSKY, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SANOFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1050
Mailing Address - Country:US
Mailing Address - Phone:630-322-9126
Mailing Address - Fax:630-995-7965
Practice Address - Street 1:2001 BUTTERFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1050
Practice Address - Country:US
Practice Address - Phone:630-322-9126
Practice Address - Fax:630-995-7965
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063661174400000X
IL036114542202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0894680Medicaid
OH0894680Medicaid
ILF400139974Medicare PIN
OHE17578Medicare UPIN