Healthcare Provider Details

I. General information

NPI: 1053709055
Provider Name (Legal Business Name): C.STEELE & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 FULTON ST
PORT CLINTON OH
43452-2069
US

IV. Provider business mailing address

PO BOX 115
PORT CLINTON OH
43452-0115
US

V. Phone/Fax

Practice location:
  • Phone: 419-967-6765
  • Fax:
Mailing address:
  • Phone: 419-732-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateOH

VIII. Authorized Official

Name: SHOSHANA EISENSTEIN
Title or Position: NP
Credential: RN,MS,NP-C
Phone: 419-967-6765