Basic Information
| Provider Information | |||||||||
| NPI: | 1457329138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITSCHKA | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 10TH AVE NE | ||||||||
| Address2: | ESSENTIA HEALTH DEER RIVER | ||||||||
| City: | DEER RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566368795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182462900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 10TH AVE NE | ||||||||
| Address2: | ESSENTIA HEALTH DEER RIVER | ||||||||
| City: | DEER RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566368795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182462900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 05/25/2016 | ||||||||
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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 | 207P00000X | 39852 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080013301 | 01 | MN | MEDICARE WPS - HOSPITAL | OTHER | 677957300 | 05 | MN | MEDICAID | 080015007 | 01 | MN | MEDICARE WPS - MCGREGOR C | OTHER | 080015008 | 01 | MN | MEDICARE WPS - AITKIN CLI | OTHER |