Provider Demographics
NPI:1093794950
Name:SATHOFF, EDWARD C (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:SATHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1400 E MADISON AVE
Practice Address - Street 2:STE 352 MANKATO CLINIC DEPT OF PSYCHIATRY
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-387-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN346732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA2951015940OtherPREFERRED ONE
IA0571703Medicaid
41084933956001F005OtherCHAMPUS
MN389R4SAOtherBCBS
MN122781OtherUCARE
MN721862100Medicaid
MN1762332OtherAMERICAS PPO
HP36170OtherHEALTH PARTNERS MN
260050339OtherRR MEDICARE
MN389R4SAOtherBCBS
260050339OtherRR MEDICARE