Provider Demographics
NPI:1124002746
Name:HOSSLER, STEVEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:HOSSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-3072
Mailing Address - Country:US
Mailing Address - Phone:260-432-1568
Mailing Address - Fax:260-432-4969
Practice Address - Street 1:6119 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-3072
Practice Address - Country:US
Practice Address - Phone:260-432-1568
Practice Address - Fax:260-432-4969
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034289A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0680473Medicaid
IN000000084887OtherBCBS
IN100328210Medicaid
000000012713OtherENCORE
300010252OtherTRAVELERS
IN006895400OtherBLACK LUNG
1414OtherPHP
000000012713OtherENCORE
D95424Medicare UPIN
IN100328210Medicaid
IN459320CMedicare ID - Type Unspecified
IN136270QQMedicare PIN