Provider Demographics
NPI:1497000988
Name:PORTO, STEVEN PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:PORTO
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 1:9489 EDGESTONE DR APT 312
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-5342
Mailing Address - Country:US
Mailing Address - Phone:954-650-9436
Mailing Address - Fax:
Practice Address - Street 1:9660 E 146TH ST STE 100
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060
Practice Address - Country:US
Practice Address - Phone:317-773-6677
Practice Address - Fax:317-773-3322
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02004784A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6776038OtherUNITED
IN300013956Medicaid
IN512461OtherANTHEM