Provider Demographics
NPI:1346203759
Name:CIABATTONI, STEVEN EMMET (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EMMET
Last Name:CIABATTONI
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 1:601 FRONT AVENUE
Mailing Address - Street 2:SUITE #502
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-415-0524
Mailing Address - Fax:208-763-3644
Practice Address - Street 1:601 FRONT AVENUE
Practice Address - Street 2:SUITE #502
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-415-0524
Practice Address - Fax:208-763-3644
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM95212085R0202X
NY1762412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3427930000OtherPASSPORT ADVANTAGE
KY91826OtherSIHO
KY000000548191OtherANTHEM
VA010348447Medicaid
NY176241OtherNYS LICENSE #
KY7100025670Medicaid
KY50017675OtherPASSPORT
KY7100025670Medicaid
KY00507009Medicare PIN
KY3427930000OtherPASSPORT ADVANTAGE
KY00533001Medicare PIN