Healthcare Provider Details

I. General information

NPI: 1871575431
Provider Name (Legal Business Name): STEVEN HOWARD NEUCKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 E 75TH STREET SUITE 110
INDIANAPOLIS IN
46250-2717
US

IV. Provider business mailing address

6330 E 75TH STREET SUITE 110
INDIANAPOLIS IN
46250-2717
US

V. Phone/Fax

Practice location:
  • Phone: 317-588-7130
  • Fax: 317-588-7133
Mailing address:
  • Phone: 317-588-7130
  • Fax: 317-588-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01029878
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01029878
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: