Active NPI
Steven Gustave Punke, M.D.
- Anesthesiology Physician
- Waterloo, IA
National Provider Identifier
1720129133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 36995
- Practice address
- 1825 Logan Ave
Waterloo, IA 50703-1916 - Phone
- (319) 235-5386
- Fax
- (319) 235-3074
- NPI assigned
- Feb 9, 2007
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 36995 | IA | Primary |
Addresses
Primary practice location
1825 Logan Ave
Waterloo, IA 50703-1916
Mailing address
PO Box 2758
Waterloo, IA 50704-2758
Phone (319) 235-5390
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 421417307M5 | Other | IA | JOHN DEERE HEALTH CARE |
| 0763631 | Medicaid | IA | |
| 31406 | Other | IA | WELLMARK |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36995 | IA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382054400000",
"number": "1720129133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2758",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507042758",
"telephone_number": "319-235-5390",
"fax_number": "319-233-1630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 LOGAN AVE",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507031916",
"telephone_number": "319-235-5386",
"fax_number": "319-235-3074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUNKE",
"first_name": "STEVEN",
"middle_name": "GUSTAVE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2013-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IA",
"license": "36995",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE HEALTH CARE",
"identifier": "421417307M5",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0763631",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "31406",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.