| Doctor Name: | DOUGLAS STEIN |
| NPI Number: | 1588928923 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 123456 |
| Business Practice Address: | 355 Ridge Ave Evanston, IL - 602023328 |
| Business Phone Number: | 8473163111 |
| Business Fax Number: | |
| Mailing Address: | 400 N Mcclurg Ct Apt 3313, CHICAGO |
| State: | IL |
| Postal Code: | 606114348 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/29/2012 |
| NPI Last Update Date: | 06/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 123456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |