Provider Demographics
NPI:1366435901
Name:MIFF, STEPHEN C (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:MIFF
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 1:2740 W FOSTER AVE
Mailing Address - Street 2:#311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:773-907-7017
Mailing Address - Fax:773-907-7016
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:#311
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-907-7017
Practice Address - Fax:773-907-7016
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085126Medicaid
IL350420OtherMEDICARE
IL036085126Medicaid