Basic Information
| Provider Information | |||||||||
| NPI: | 1487735619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOVITZ | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE STREET SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123590475 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 EAST FRANKLIN AVENUE | ||||||||
| Address2: | UFP-SMILEY'S CLINIC | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123590475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | 41738 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | HP30928 | 01 | MN | HEALTH PARTNERS | OTHER | 1125009 | 01 | MN | ARAZ | OTHER | 127986 | 01 | MN | UCARE | OTHER | 32G40ST | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 01-04582 | 01 | MN | MEDICA PRIMARY | OTHER | 01-04582 | 01 | MN | MEDICA CHOICE | OTHER | 1024575 | 01 | MN | PREFERRED ONE | OTHER | 118420200 | 05 | MN | MEDICAID |