Provider Demographics
NPI:1619080470
Name:HEAD, STEVEN DALE (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DALE
Last Name:HEAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-239-2018
Practice Address - Street 1:3901 CENTRAL PIKE STE 353
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3422
Practice Address - Country:US
Practice Address - Phone:615-220-8788
Practice Address - Fax:615-220-8688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM268213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ079989Medicaid
TN4449571OtherCIGNA
TN2740051OtherUNITED HEALTH CARE
TN0002337OtherHEALTHSPRINGS
TN0038094OtherBCBS
TN3351095Medicaid
TN3351095Medicare PIN
TN5481446OtherAETNA
TN3351095Medicaid