Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 23647 | MN |
NPI | 1003830613 |
---|---|
Provider Name | Thomas Stealey |
First Address | Edina, MN 55435-2131 |
Second Address | Edina, MN 55435-2131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1201801 | MEDICA (01) | MN |
16734ST | BLUE CROSS BLUE SHIELD (01) | MN |
CP9020830004 | PREFERRED ONE (01) | |
F46850 | (02) | MN |