Stephen J Bundra MD SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036069601 Issued in IL

Legal business name

STEPHEN J BUNDRA MD SC

Practice address

1921 Lake Ave Ste B
Wilmette, IL 60091-1480

Phone

(847) 853-9104

NPI assigned

Jan 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephen J Bundra, M.D.NPI 1326064387

Title

President

Phone

(847) 853-9104

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen J Bundra, MD

  • Family Medicine Physician
  • Wilmette, IL
  • NPI 1326064387
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1770638959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 LAKE AVE STE B",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911480",
            "telephone_number": "847-853-9104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 LAKE AVE STE B",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911480",
            "telephone_number": "847-853-9104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN J BUNDRA MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "BUNDRA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-853-9104",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036069601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Marguerite LTD
• Daniel Stalilonis, LCSW
• Anna Maria Stankiewicz, M.D.
• Abby Staunton, PTA
• Stephanie Wright PHD PC
• Laurie Kathleen Stogin
• Tina Strauss-Hoder, CNP
• Nathan Q Studnicka
• Fred Stulp, M.D.
• Jeffrey Sturt, RPHBS

• Internal Medicine Physician in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.