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General NPI Number Information
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NPI Number | 1215575790
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Entity Type | Individual
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Provider Name | STEVEN BOYD FUGATE HOME MODIFICATIONS
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Gender | Male
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 217 W WILLIAM ST
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-4234
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Country | US
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Telephone | 219-707-8240
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Fax | 219-262-5093
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Provider Business Mailing Address
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Address Line | 6212 US HIGHWAY 6 STE 225
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City | PORTAGE
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State | IN
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Zip | 46368-5057
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Country | US
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Telephone | 219-730-7023
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Fax | 219-262-5093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 2012050200489
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License Number State | IN
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