Provider Demographics
NPI:1205800679
Name:ARVANITIS, STEVEN
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:ARVANITIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JOHN DEERE RD
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6812
Mailing Address - Country:US
Mailing Address - Phone:309-779-3627
Mailing Address - Fax:
Practice Address - Street 1:600 JOHN DEERE RD
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6869
Practice Address - Country:US
Practice Address - Phone:309-779-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101747002Medicaid
IA3201277Medicaid
362739299-001OtherTRICARE/HEALTH NET
IL0182OtherJOHN DEERE
193139OtherIHS
95144OtherWELLMARK
362739299001OtherTRICARE
IA2201277Medicaid
H08773Medicare UPIN
IA2201277Medicaid
362739299001OtherTRICARE