Provider Demographics
NPI:1619950375
Name:DONATELLO, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:DONATELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W RIVER WOODS PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1010
Mailing Address - Country:US
Mailing Address - Phone:414-961-0304
Mailing Address - Fax:414-961-2061
Practice Address - Street 1:525 W RIVER WOODS PKWY STE 130
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1010
Practice Address - Country:US
Practice Address - Phone:414-249-2420
Practice Address - Fax:414-961-0298
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37794-020208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32256600Medicaid
WI0017-73375Medicare ID - Type UnspecifiedPROVIDER NUMBER
000101438Medicare PIN
WI32256600Medicaid
WI0016-46195Medicare ID - Type UnspecifiedPROVIDER NUMBER