Provider Demographics
NPI:1720060957
Name:POE, STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:POE
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 1:1251 KEM ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2555
Mailing Address - Country:US
Mailing Address - Phone:765-662-4133
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:330 N WABASH
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46933
Practice Address - Country:US
Practice Address - Phone:765-662-4198
Practice Address - Fax:765-662-4012
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001296A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN296260DDMedicare PIN
E39559Medicare UPIN