Basic Information
Provider Information | |||||||||
NPI: | 1235210659 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STAHL | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | R. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 501 N STATE ST | ||||||||
Address2: | WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM | ||||||||
City: | WASECA | ||||||||
State: | MN | ||||||||
PostalCode: | 560930000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5078351210 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 501 N STATE ST | ||||||||
Address2: | WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM | ||||||||
City: | WASECA | ||||||||
State: | MN | ||||||||
PostalCode: | 560930000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5078351210 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/19/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 40815 | MN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 01-17793 | 01 | MN | MEDICA | OTHER | HP28952 | 01 | MN | HEALTH PARTNERS | OTHER | NA9501022752 | 01 | MN | PREFERRED ONE | OTHER | 39-09161 | 01 | MN | MEDICA | OTHER | 127828 | 01 | MN | UCARE | OTHER | 72Q86ST | 01 | MN | BCBS | OTHER | 38P94ST | 01 | MN | BCBS | OTHER | CN7693 | 01 | MN | MEDICARE RAILROAD | OTHER |