Basic Information
| Provider Information | |||||||||
| NPI: | 1578537056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 N 7TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122387631 | ||||||||
| FaxNumber: | 8122387003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 N 7TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122387631 | ||||||||
| FaxNumber: | 8122387003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01027543A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080151014 | 01 | IN | RAILROAD MEDICARE | OTHER | 100252290 | 05 | IN | MEDICAID |