Provider Demographics
NPI:1578523882
Name:NEELEMAN, STEPHEN D I (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:NEELEMAN
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LONE
Other - Middle Name:PEAK
Other - Last Name:SURGERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-855-2944
Mailing Address - Fax:801-756-5091
Practice Address - Street 1:1159 E 200 N
Practice Address - Street 2:STE 350
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2022
Practice Address - Country:US
Practice Address - Phone:801-855-2944
Practice Address - Fax:801-756-5091
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58755561205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000065578Medicare PIN
UT005802801Medicare ID - Type UnspecifiedMEDICARE
UTH94598Medicare UPIN