Basic Information
Provider Information
NPI: 1477660991
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUNTER
FirstName: STEVEN
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3301 W FOREST HOME AVE
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532152843
CountryCode: US
TelephoneNumber: 4146476326
FaxNumber: 4146718860
Practice Location
Address1: 36500 AURORA DR
Address2:  
City: SUMMIT
State: WI
PostalCode: 530664899
CountryCode: US
TelephoneNumber: 2624345000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/23/2006
LastUpdateDate: 12/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X31327WIY Allopathic & Osteopathic PhysiciansDermatology 

ID Information
IDTypeStateIssuerDescription
BH232746001 DEA NUMBEROTHER
3162670005WI MEDICAID


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