Healthcare Provider Details

I. General information

NPI: 1407419997
Provider Name (Legal Business Name): COLIN STEINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 HOLY CROSS PKWY
MISHAWAKA IN
46545-1469
US

IV. Provider business mailing address

600 EAST BLVD
ELKHART IN
46514-2483
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-5000
  • Fax:
Mailing address:
  • Phone: 574-271-2558
  • Fax: 574-523-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02006798A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: