Provider Demographics
NPI:1548257645
Name:SPARKS, STEVEN B (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1723 COLUMBUS AVE
Mailing Address - Street 2:STE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3546
Mailing Address - Country:US
Mailing Address - Phone:419-626-5252
Mailing Address - Fax:419-626-5335
Practice Address - Street 1:1723 COLUMBUS AVE
Practice Address - Street 2:STE D
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3546
Practice Address - Country:US
Practice Address - Phone:419-626-5252
Practice Address - Fax:419-626-5335
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2007-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34004735208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000258765OtherANTHEM BLUE CROSS
OH0743584Medicaid
OH000000258765OtherANTHEM BLUE CROSS
E41408Medicare UPIN