Provider Demographics
NPI:1962631267
Name:DUSSEAU, STEVEN P (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:DUSSEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3578 FISHINGER BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7503
Mailing Address - Country:US
Mailing Address - Phone:614-457-4806
Mailing Address - Fax:614-457-0269
Practice Address - Street 1:3578 FISHINGER BLVD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7503
Practice Address - Country:US
Practice Address - Phone:614-457-4806
Practice Address - Fax:614-457-0269
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065048Medicaid
OHH105520Medicare PIN