Basic Information
| Provider Information | |||||||||
| NPI: | 1396907952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEURY | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7611 HURSH RD | ||||||||
| Address2: | |||||||||
| City: | LEO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467659538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174435753 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3707 NEW VISION DR | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604694763 | ||||||||
| FaxNumber: | 2604845919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 01/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 11014479A | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 11014479A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.