Provider Demographics
NPI:1992779433
Name:MOTARJEME, STEVEN CYRUS (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CYRUS
Last Name:MOTARJEME
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 1:1516 E DEAN RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2406
Mailing Address - Country:US
Mailing Address - Phone:239-357-6135
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203446207P00000X
MS20260207P00000X
WI39706-020207R00000X, 208000000X, 207P00000X
MAMD.203446208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1369446Medicaid
LA1369446Medicaid
MS01856584Medicaid
WI32418800Medicaid
LA4M747DJ97Medicare PIN
LA1369446Medicaid
MS302I934755Medicare PIN
LA4M747DN95Medicare PIN
MS512I930437Medicare PIN
WI008702905Medicare PIN
WIF76873Medicare UPIN
WI005801930Medicare ID - Type Unspecified
WI000601473Medicare PIN