Provider Demographics
NPI:1932165636
Name:MCCANN, STEVEN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRUCE
Last Name:MCCANN
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 1:19475 W NORTH AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4199
Mailing Address - Country:US
Mailing Address - Phone:262-780-4000
Mailing Address - Fax:262-780-4090
Practice Address - Street 1:19475 W NORTH AVE
Practice Address - Street 2:STE 400
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4199
Practice Address - Country:US
Practice Address - Phone:262-780-4000
Practice Address - Fax:262-780-4090
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32337000Medicaid
WI32813500Medicaid
733700005Medicare ID - Type Unspecified
WI32337000Medicaid