Headley, Stephen V
Headley, Stephen V is an individual health care provider with primary practice located at 3283 Willowcreek Rd , Portage IN 46368-5054. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Headley, Stephen V can be contacted via phone (219) 764-8439.Contact Information
Primary practice address
3283 Willowcreek Rd
Portage IN 46368-5054
Phone: (219) 764-8439
Fax: (219) 764-8463
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036105186 | Illinois |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 02005477A | Indiana |
Profile Details
| NPI number | 1679663603 |
|---|---|
| LBN Legal business name | Headley, Stephen V |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 13th, 2006 |
| Last updated | Apr 18th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679663603 | NPPES |
| Illinois | MEDICAID | 036105186 |
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