Provider Demographics
NPI:1700882693
Name:ZEIDNER, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ZEIDNER
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 1:3000 REGENCY CT
Mailing Address - Street 2:STE 207
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3092
Mailing Address - Country:US
Mailing Address - Phone:419-471-0493
Mailing Address - Fax:419-474-0390
Practice Address - Street 1:3000 REGENCY CT
Practice Address - Street 2:STE 207
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3092
Practice Address - Country:US
Practice Address - Phone:419-471-0493
Practice Address - Fax:419-474-0390
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350381402085R0001X
MI43010561462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH920005077OtherRR MEDICARE
MI4153920OtherMI MEDICAID-OH LOCATIONS
MI0N24000008OtherMEDICARE
MI4283011Medicaid
OH0415269Medicaid
MI920006285OtherRR MEDICARE
MI4283011Medicaid
MI920006285OtherRR MEDICARE
OHZE0629643Medicare ID - Type Unspecified