Provider Demographics
NPI:1720129133
Name:PUNKE, STEVEN GUSTAVE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GUSTAVE
Last Name:PUNKE
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:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-233-1630
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-5386
Practice Address - Fax:319-235-3074
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36995207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421417307M5OtherJOHN DEERE HEALTH CARE
IA0763631Medicaid
IA31406OtherWELLMARK
IA421417307M5OtherJOHN DEERE HEALTH CARE
I69307Medicare UPIN