1275512261 NPI number — STEPHANIE W PUTZIER MD

Table of content: STEPHANIE W PUTZIER MD (NPI 1275512261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275512261 NPI number — STEPHANIE W PUTZIER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUTZIER
Provider First Name:
STEPHANIE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1275512261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 COUNTRY CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56001-9338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-380-3644
Provider Business Mailing Address Fax Number:
507-345-1553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3530 LEXINGTON AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOREVIEW
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55126-8166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-714-0200
Provider Business Practice Location Address Fax Number:
651-714-0201
Provider Enumeration Date:
01/10/2006

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: 207R00000X , with the licence number:  35972 , 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: 1966132 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 958583400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0401916 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 121151 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP25864 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 410849339 56001 C077 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NA2951023855 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 110103558 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1M944PU . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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