Provider Demographics
NPI:1972530699
Name:STEVEN, GARY C (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:STEVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8585 W FOREST HOME AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3417
Mailing Address - Country:US
Mailing Address - Phone:414-529-8500
Mailing Address - Fax:414-529-8511
Practice Address - Street 1:8585 W FOREST HOME AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3417
Practice Address - Country:US
Practice Address - Phone:414-529-8500
Practice Address - Fax:414-529-8511
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI33574020174400000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG32673Medicare UPIN
WI000068079Medicare PIN