Provider Demographics
NPI:1083657134
Name:ARCHIBALD, STEVEN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ANDREW
Last Name:ARCHIBALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:401 E. ONTARIO ST.
Practice Address - Street 2:#4601
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4444
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1046962085R0202X
AZ352622085R0202X
CAG876972085R0202X
IDM95312085R0202X
IN01061626A2085R0202X
MI43010871032085R0202X
MN11672085R0202X
NMTM2006-00172085R0202X
NY2395532085R0202X
NC2006-004722085R0202X
OH25.0000572085R0202X
PAMD4284552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology