Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 28362 | MN |
NPI | 1144248956 |
---|---|
Provider Name | Thomas L Satterberg |
First Address | St Cloud, MN 56303 |
Second Address | St Cloud, MN 56303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106931 | UCARE (01) | |
1324453 | MEDICA (01) | |
41018SA | BCBS (01) | |
532004 | P ONE (01) | |
E49233 | (02) |