Provider Demographics
NPI:1578214482
Name:MCCASKILL, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MCCASKILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 FRANKLIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4516
Mailing Address - Country:US
Mailing Address - Phone:920-682-8830
Mailing Address - Fax:
Practice Address - Street 1:1006 FRANKLIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4516
Practice Address - Country:US
Practice Address - Phone:920-682-8830
Practice Address - Fax:920-682-8860
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19325410305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No305S00000XManaged Care OrganizationsPoint of Service