Provider Demographics
NPI:1841476397
Name:SHOEMAKER, STEVEN K (DPM)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 DOUGLAS BLVD
Mailing Address - Street 2:#306 -165
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-5936
Mailing Address - Country:US
Mailing Address - Phone:916-781-3223
Mailing Address - Fax:916-781-3019
Practice Address - Street 1:1421 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6045
Practice Address - Country:US
Practice Address - Phone:916-781-3223
Practice Address - Fax:916-781-3019
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3540213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00293318OtherRAIL ROAD MEDICARE INDIVIDUAL PROVIDER #
CAP00293318OtherRAIL ROAD MEDICARE INDIVIDUAL PROVIDER #
CA00E35401Medicare PIN
CAP00293318Medicare Oscar/Certification
CA5611270001Medicare NSC