Provider Demographics
NPI:1194854737
Name:STEVEN K. SHOEMAKER, DPM AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:STEVEN K. SHOEMAKER, DPM AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-781-3223
Mailing Address - Street 1:4120 DOUGLAS BLVD # 306-165
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-5936
Mailing Address - Country:US
Mailing Address - Phone:916-781-3223
Mailing Address - Fax:916-781-8171
Practice Address - Street 1:1421 SECRET RAVINE PKWY STE 111
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6045
Practice Address - Country:US
Practice Address - Phone:916-781-3223
Practice Address - Fax:916-781-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3540213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHD137336OtherRADIOLOGY
CA10972127OtherCAQH
CA10972127OtherCAQH
CARHD137336OtherRADIOLOGY
CA10972127OtherCAQH