MEDICARE: DR. STEVEN ROGER QUAM D.O.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	1759	IA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	1759	IA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CD9106	OTHER	IA	RR MEDICARE
4	50171	OTHER	IA	GROUP MEDICARE NUMBER

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50177	OTHER	IA	WELLMARK # (GROUP #)
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1780681551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ROGER QUAM D.O.

Provider Business Mailing Address
First Line	:	5901 WESTOWN PKWY
Second Line	:	SUITE 210
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8218
Country	:	US
Telephone Number	:	515-221-9222
Fax Number	:	515-221-0575

Provider Business Practice Location Address
First Line	:	5901 WESTOWN PKWY
Second Line	:	SUITE 210
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8218
Country	:	US
Telephone Number	:	515-221-9222
Fax Number	:	515-221-0575

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/09/2014

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308