Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 26395 | NE |
Y | 207XX0801X | Orthopaedic Trauma Surgeon | 64946 | MN |
NPI | 1023339645 |
---|---|
Provider Name | Dr. Gregory Richard Staeheli |
First Address | Minneapolis, MN 55415-1829 |
Second Address | Minneapolis, MN 55415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 06/10/2020 |