Provider Demographics
NPI:1710978333
Name:WALTZ, STEVEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:WALTZ
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:PO BOX 2505
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2505
Mailing Address - Country:US
Mailing Address - Phone:812-238-7783
Mailing Address - Fax:812-238-4506
Practice Address - Street 1:727 N LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1117
Practice Address - Country:US
Practice Address - Phone:765-569-1123
Practice Address - Fax:765-569-6412
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110020283OtherRR MEDICARE
IN100200590Medicaid
INP00448381OtherRR MEDICARE
INP00448381OtherRR MEDICARE
IN620760Medicare PIN
IN252060A1Medicare PIN
B29320Medicare UPIN
IN110020283OtherRR MEDICARE
IN941090A11Medicare PIN
INP00448381Medicare PIN