Basic Information
| Provider Information | |||||||||
| NPI: | 1437241312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 OSBORNE RD NE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637861620 | ||||||||
| FaxNumber: | 7637803099 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 OSBORNE RD NE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637861620 | ||||||||
| FaxNumber: | 7637803099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/18/2011 | ||||||||
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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 | 207RH0003X | 38246 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 909019300 | 05 | MN | MEDICAID | HP17750 | 01 | MN | HEALTH PARTNERS | OTHER | 3600800 | 01 | MN | SELECT CARE | OTHER | 3600800 | 01 | MN | MEDICA | OTHER | 7K191MA | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 109519 | 01 | MN | UCARE | OTHER | 963001008878 | 01 | MN | PREFERRED ONE | OTHER | 410729979 | 01 | MN | COMMERCIAL | OTHER |