Provider Demographics
NPI:1861462350
Name:CARLSON, STEVEN C (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 23RD ST
Mailing Address - Street 2:STE C
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1158
Mailing Address - Country:US
Mailing Address - Phone:712-336-3750
Mailing Address - Fax:712-336-3730
Practice Address - Street 1:2700 23RD ST
Practice Address - Street 2:STE C
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1158
Practice Address - Country:US
Practice Address - Phone:712-336-3750
Practice Address - Fax:712-336-3730
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2162917Medicaid
IA2162917Medicaid