1164424974 NPI number — SIMON MILSTEIN MD

Table of content: SIMON MILSTEIN MD (NPI 1164424974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164424974 NPI number — SIMON MILSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILSTEIN
Provider First Name:
SIMON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164424974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 6TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-252-5131
Provider Business Mailing Address Fax Number:
320-240-2118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 6TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-252-5131
Provider Business Practice Location Address Fax Number:
320-240-2118
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X , with the licence number:  30710 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1012851 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1733471 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: COMP . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: COMP . This is a "ONE HEALTH PLANGREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-26-2003 . This is a "MMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2501032 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25174 . This is a "ST CLOUD HOSPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP13986 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 059K2MI . This is a "BLUE CROSS BLUE SHEILD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 338088200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100318 . This is a "U-CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 338088200 . This is a "MEDICAL ASSISTANCE (MA)" identifier . This identifiers is of the category "OTHER".




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