Provider Demographics
NPI:1356419378
Name:SENICA, STEVEN L (MD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:L
Last Name:SENICA
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 1:13060 ISLE DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8331
Mailing Address - Country:US
Mailing Address - Phone:218-855-5473
Mailing Address - Fax:218-454-5936
Practice Address - Street 1:13060 ISLE DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8331
Practice Address - Country:US
Practice Address - Phone:218-855-5473
Practice Address - Fax:218-454-5936
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0369092176207V00000X
MN56720207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092176Medicaid
ILL83646Medicare ID - Type Unspecified
IL036092176Medicaid