Basic Information
| Provider Information | |||||||||
| NPI: | 1700882693 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZEIDNER | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 REGENCY CT | ||||||||
| Address2: | STE 207 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194710493 | ||||||||
| FaxNumber: | 4194740390 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 REGENCY CT | ||||||||
| Address2: | STE 207 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194710493 | ||||||||
| FaxNumber: | 4194740390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 09/11/2012 | ||||||||
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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 | 2085R0001X | 35038140 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 4301056146 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 920005077 | 01 | OH | RR MEDICARE | OTHER | 4153920 | 01 | MI | MI MEDICAID-OH LOCATIONS | OTHER | 0N24000008 | 01 | MI | MEDICARE | OTHER | 4283011 | 05 | MI | MEDICAID | 0415269 | 05 | OH | MEDICAID | 920006285 | 01 | MI | RR MEDICARE | OTHER |