Provider Demographics
NPI:1861557399
Name:STEGEMANN, TIMOTHY
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:STEGEMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TOWER CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3322
Mailing Address - Country:US
Mailing Address - Phone:847-599-0715
Mailing Address - Fax:
Practice Address - Street 1:30 TOWER CT
Practice Address - Street 2:SUITE C
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3322
Practice Address - Country:US
Practice Address - Phone:847-599-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9687207Q00000X
IL0368127891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine