Provider Demographics
NPI:1356540082
Name:STEUK, GREGORY LEE
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LEE
Last Name:STEUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 220TH ST
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8022
Mailing Address - Country:US
Mailing Address - Phone:712-943-5242
Mailing Address - Fax:
Practice Address - Street 1:1447 220TH ST
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8022
Practice Address - Country:US
Practice Address - Phone:712-943-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0251041171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0251041Medicaid