Provider Demographics
NPI:1821098146
Name:SCHOENECKER, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:SCHOENECKER
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 26730
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-3730
Mailing Address - Country:US
Mailing Address - Phone:253-661-1700
Mailing Address - Fax:253-661-4565
Practice Address - Street 1:533 S 336TH ST
Practice Address - Street 2:STE C
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6329
Practice Address - Country:US
Practice Address - Phone:253-661-1700
Practice Address - Fax:253-661-4565
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000217642085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8632408Medicaid
AB38661Medicare PIN
000159714Medicare PIN
8854130Medicare PIN
WAD99497Medicare UPIN