Provider Demographics
NPI:1174501829
Name:BOARDMAN, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:BOARDMAN
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 1:520 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6194
Mailing Address - Country:US
Mailing Address - Phone:309-762-3621
Mailing Address - Fax:309-762-3690
Practice Address - Street 1:520 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6152
Practice Address - Country:US
Practice Address - Phone:309-762-3621
Practice Address - Fax:309-762-3690
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113720207X00000X
IA36130207X00000X
AZ31297207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
91897OtherWELLMARK
IL036113720Medicaid
247583OtherMIDLANDS CHOICE
526250OtherIA HEALTH SOLUTIONS
P00244907OtherRR MEDICARE
106804OtherHEALTH ALLIANCE
IL8121085OtherBCBS
91904OtherWELLMARK
ILIL01B8OtherJOHN DEERE FAMILY
IA0593806Medicaid
39250OtherWELLMARK
I30716Medicare UPIN
91897OtherWELLMARK
IL036113720Medicaid