MEDICARE: STEVEN TODD WALLENIUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	009601172	NC
2	207Q00000X	Family Medicine Physician	95799	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457446163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN TODD WALLENIUS M.D.

Provider Business Mailing Address
First Line	:	101 N PINE ST STE 200
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1604
Country	:	US
Telephone Number	:	828-582-7773
Fax Number	:	864-582-8637

Provider Business Practice Location Address
First Line	:	101 N PINE ST STE 200
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1604
Country	:	US
Telephone Number	:	864-582-7773
Fax Number	:	864-582-8637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	04/15/2026

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