Provider Demographics
NPI:1457469751
Name:STEELE, CARL W (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:STEELE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2069
Mailing Address - Country:US
Mailing Address - Phone:419-732-2614
Mailing Address - Fax:419-734-0106
Practice Address - Street 1:619 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2069
Practice Address - Country:US
Practice Address - Phone:419-732-2614
Practice Address - Fax:419-734-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH116646OtherANTHEM BCBS OF OHIO
OH0846651Medicaid
OHST0697711Medicare ID - Type Unspecified
OH0846651Medicaid