Healthcare Provider Details

I. General information

NPI: 1972530699
Provider Name (Legal Business Name): GARY C STEVEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 W FOREST HOME AVE SUITE 200
GREENFIELD WI
53228-3417
US

IV. Provider business mailing address

8585 W FOREST HOME AVE SUITE 200
GREENFIELD WI
53228-3417
US

V. Phone/Fax

Practice location:
  • Phone: 414-529-8500
  • Fax: 414-529-8511
Mailing address:
  • Phone: 414-529-8500
  • Fax: 414-529-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33574020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number33574020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: