Provider Demographics
NPI:1215575790
Name:FUGATE, STEVEN BOYD (HOME MODIFICATIONS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BOYD
Last Name:FUGATE
Suffix:
Gender:M
Credentials:HOME MODIFICATIONS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 US HIGHWAY 6 STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5057
Mailing Address - Country:US
Mailing Address - Phone:219-730-7023
Mailing Address - Fax:219-262-5093
Practice Address - Street 1:217 W WILLIAM ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4234
Practice Address - Country:US
Practice Address - Phone:219-707-8240
Practice Address - Fax:219-262-5093
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2012050200489171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications