Provider Demographics
NPI:1306919907
Name:GILES, STEVEN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
Last Name:GILES
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 1:3316 RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1282
Mailing Address - Country:US
Mailing Address - Phone:262-352-9973
Mailing Address - Fax:978-291-1768
Practice Address - Street 1:3316 RIDGELINE DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-352-9973
Practice Address - Fax:978-291-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52096207QS0010X
OH35.133627207QS0010X
WI23060207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC52096OtherMEDICAL LICENSE
OH35.133627OtherMEDICAL LICENSE
SC2052096OtherCONTROLLED SUBSTANCES REGISTRATION
WI30346300Medicaid
WI23060OtherMEDICAL LICENSE
WI23060OtherMEDICAL LICENSE