MEDICARE: DR. STEVEN C PORT MD

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	207UN0901X	Nuclear Cardiology Physician	25008	WI
2	207RC0000X	Cardiovascular Disease Physician	25008	WI

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

General Provider Information

NPI Number	:	1598765471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN C PORT MD

Provider Business Mailing Address
First Line	:	PO BOX 2040
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-2040
Country	:	US
Telephone Number	:	414-649-3530
Fax Number	:	414-649-3551

Provider Business Practice Location Address
First Line	:	2801 W KINNICKINNIC RIVER PKWY
Second Line	:	#840
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3669
Country	:	US
Telephone Number	:	414-649-3530
Fax Number	:	414-649-3551

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	04/26/2022

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Directions to “ DR. STEVEN C PORT MD” Practice Location

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