Healthcare Provider Details

I. General information

NPI: 1639164064
Provider Name (Legal Business Name): STEVEN W NEUBAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 PLAINFIELD RD
CREST HILL IL
60403-1865
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-4343
  • Fax: 815-741-8660
Mailing address:
  • Phone: 920-663-9016
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036079908
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: