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Individual

STEVEN PAUL VANDER LEEST

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
2700 23RD ST, STE C, SPIRIT LAKE, IA 51360-1158
(712) 336-3750
(712) 336-3730
Mailing address
2700 23RD ST, STE C, SPIRIT LAKE, IA 51360-1158

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3729
IA
207Q00000X
Family Medicine Physician
Primary
IA3729
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0144840
MEDICAID GROUP NUMBER
IA
05
07442684
IA
01
54897
MEDICARE GROUP NUMBER
IA
Enumeration date
08/01/2006
Last updated
01/06/2012
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