Provider Demographics
NPI:1992771257
Name:KO, STEVEN D (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:KO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-434-6392
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01048660A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087425OtherANTHEM
OH2065358Medicaid
660002143OtherRAILROAD
IN200176600Medicaid
ING22523Medicare UPIN
IN260690MMMedicare PIN
IN058490FFFMedicare ID - Type Unspecified