Basic Information
| Provider Information | |||||||||
| NPI: | 1629068382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELG | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7147 VISTA DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502669313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158759925 | ||||||||
| FaxNumber: | 5158759923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 PLEASANT ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152414161 | ||||||||
| FaxNumber: | 5152414162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD-38496 | IA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | MD-38496 | IA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3159290 | 01 | TN | BLUECROSS BLUESHIELD/TN | OTHER | 3159290 | 01 | TN | TNCARE SELECT | OTHER | 3159290 | 01 | TN | BLUECARD | OTHER | 3159290 | 01 | TN | BLUECARE | OTHER |