Healthcare Provider Details

I. General information

NPI: 1952139941
Provider Name (Legal Business Name): COLTON MICHAEL STEIDINGER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 TRINITY LN STE 111
BLOOMINGTON IL
61704-8112
US

IV. Provider business mailing address

1111 TRINITY LN STE 111
BLOOMINGTON IL
61704-8112
US

V. Phone/Fax

Practice location:
  • Phone: 309-608-5100
  • Fax:
Mailing address:
  • Phone: 309-608-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030074
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number1548276256
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: