Active NPI
Steven Michael Staab, LAT, PES-NASM
- Athletic Trainer
- Waukesha, WI
National Provider Identifier
1679638746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 631-039
- Practice address
- 100 N East Ave
Van Male Training Room
Waukesha, WI 53186-3103 - Phone
- (262) 524-7379
- Fax
- (262) 524-7376
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 631-039 | WI | Primary |
Addresses
Primary practice location
100 N East Ave
Van Male Training Room
Waukesha, WI 53186-3103
Mailing address
2012 Cliff Alex CT S Unit D
Waukesha, WI 53189-2127
Phone (262) 391-9495
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 631-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679638746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 CLIFF ALEX CT S UNIT D",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531892127",
"telephone_number": "262-391-9495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N EAST AVE",
"address_2": "VAN MALE TRAINING ROOM",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531863103",
"telephone_number": "262-524-7379",
"fax_number": "262-524-7376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAAB",
"first_name": "STEVEN",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "LAT, PES-NASM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "631-039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.