Basic Information
Provider Information | |||||||||
NPI: | 1801837349 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEELY | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | WAYNE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7595 ANAGRAM DR | ||||||||
Address2: |   | ||||||||
City: | EDEN PRAIRIE | ||||||||
State: | MN | ||||||||
PostalCode: | 553447399 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6125732200 | ||||||||
FaxNumber: | 6125732274 | ||||||||
Practice Location | |||||||||
Address1: | 7595 ANAGRAM DR | ||||||||
Address2: |   | ||||||||
City: | EDEN PRAIRIE | ||||||||
State: | MN | ||||||||
PostalCode: | 553447399 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6125732200 | ||||||||
FaxNumber: | 6125732274 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 27203 | MN | Y |   | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
ID | Type | State | Issuer | Description | 23016 | 01 | MN | AMERICA'S PPO | OTHER | 239259 | 01 | MN | MIDLANDS CHOICE INC | OTHER | 342SOST | 01 | MN | BLUE CROSS | OTHER | 100716 | 01 | MN | UCARE | OTHER | 300011436 | 01 | WI | RAILROAD MEDICARE WI | OTHER | 381580300 | 05 | MN |   | MEDICAID | 1907667 | 05 | IA |   | MEDICAID | 23699 | 01 | ND | BLUE CROSS BLUE SHIELD | OTHER | 496O9ST | 01 | MN | BLUE CROSS | OTHER | 300131999 | 01 | MN | RAILROAD MEDICARE MN | OTHER | 1016653 | 01 | MN | PREFERRED ONE | OTHER | HP14473 | 01 | MN | HEALTHPARTNERS | OTHER | 1801837349 | 01 | MN | DAKOTA CARE | OTHER | 31896600 | 05 | WI |   | MEDICAID |