Provider Demographics
NPI:1740241538
Name:IMMERMAN, STEVEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:IMMERMAN
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 1:719 W HAMILTON AVE
Mailing Address - Street 2:C
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6968
Mailing Address - Country:US
Mailing Address - Phone:715-832-1044
Mailing Address - Fax:715-832-0520
Practice Address - Street 1:719 W HAMILTON AVE
Practice Address - Street 2:C
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6968
Practice Address - Country:US
Practice Address - Phone:715-832-1044
Practice Address - Fax:715-832-0520
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23570208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42986OtherHEALTH PARTNERS
WI17-13729OtherMEDICA/SELECT CARE
WI30428200Medicaid
WI42986OtherHEALTH PARTNERS
WI020000932Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI17-13729OtherMEDICA/SELECT CARE