Basic Information
| Provider Information | |||||||||
| NPI: | 1013996032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENKHUS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8674 | ||||||||
| Address2: | 123 E MAIN ST | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 22584 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160025570 | 01 | RR MEDICARE | OTHER | 688705800 | 05 | MN | MEDICAID | HP25860 | 01 | MN | HEALTH PARTNERS | OTHER | 115550 | 01 | MN | UCARE | OTHER | 771902 | 01 | MN | AMERICAS PPO | OTHER | 41084933956001C059 | 01 | CHAMPUS | OTHER | 0702739 | 01 | MN | MEDICA | OTHER | 41497PE | 01 | MN | BCBS | OTHER | 928614 | 05 | IA | MEDICAID | NA2951023851 | 01 | MN | PREFERRED ONE | OTHER |