Provider Demographics
NPI:1871554766
Name:TOLKAN, STEVEN R (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:TOLKAN
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 1:1525 WEBSTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4935
Mailing Address - Country:US
Mailing Address - Phone:707-423-2510
Mailing Address - Fax:707-425-4236
Practice Address - Street 1:1525 WEBSTER ST STE A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4935
Practice Address - Country:US
Practice Address - Phone:707-423-2506
Practice Address - Fax:707-429-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83696207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C88487Medicare UPIN
CA00G836960Medicare ID - Type Unspecified