Basic Information
| Provider Information | |||||||||
| NPI: | 1164424974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILSTEIN | ||||||||
| FirstName: | SIMON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 6TH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 6TH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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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 | 207RC0001X | 30710 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 1012851 | 01 | PREFERRED ONE | OTHER | 1733471 | 01 | FIRST HEALTH PLAN | OTHER | COMP | 01 | CHAMPUS | OTHER | COMP | 01 | ONE HEALTH PLANGREAT WEST | OTHER | 06-26-2003 | 01 | MMSI | OTHER | 2501032 | 01 | MEDICA HEALTH PLANS | OTHER | 25174 | 01 | ST CLOUD HOSPITAL | OTHER | HP13986 | 01 | HEALTH PARTNERS | OTHER | 059K2MI | 01 | BLUE CROSS BLUE SHEILD | OTHER | 338088200 | 05 | MN | MEDICAID | 100318 | 01 | U-CARE | OTHER | 338088200 | 01 | MEDICAL ASSISTANCE (MA) | OTHER |