Provider Demographics
NPI:1194995480
Name:WANEK, STEVEN ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
Last Name:WANEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 MEDINA RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9311
Mailing Address - Country:US
Mailing Address - Phone:330-722-3083
Mailing Address - Fax:330-725-5043
Practice Address - Street 1:3780 MEDINA RD
Practice Address - Street 2:STE. 200
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9311
Practice Address - Country:US
Practice Address - Phone:330-722-3083
Practice Address - Fax:330-725-5043
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4250581OtherMEDICARE ID
OH4250582OtherMEDICARE ID
OH2884928Medicaid
OH4250584OtherMEDICARE ID