Basic Information
| Provider Information | |||||||||
| NPI: | 1700222064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RASMUSSEN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 N 8TH AVE E | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187231112 | ||||||||
| FaxNumber: | 2185299120 | ||||||||
| Practice Location | |||||||||
| Address1: | 1080 W FOND DU LAC ST | ||||||||
| Address2: | |||||||||
| City: | RIPON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549719286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207487000 | ||||||||
| FaxNumber: | 9207487236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 58181 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 68748 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1700222064 | 05 | MN | MEDICAID | 0001-0117091 | 01 | MEDICA | OTHER | 1700222064 | 01 | MN | BCBS | OTHER |