Provider Demographics
NPI:1164424974
Name:MILSTEIN, SIMON (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:MILSTEIN
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 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30710207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012851OtherPREFERRED ONE
1733471OtherFIRST HEALTH PLAN
COMPOtherCHAMPUS
COMPOtherONE HEALTH PLANGREAT WEST
06-26-2003OtherMMSI
2501032OtherMEDICA HEALTH PLANS
25174OtherST CLOUD HOSPITAL
HP13986OtherHEALTH PARTNERS
059K2MIOtherBLUE CROSS BLUE SHEILD
MN338088200Medicaid
100318OtherU-CARE
338088200OtherMEDICAL ASSISTANCE (MA)
HP13986OtherHEALTH PARTNERS
A94864Medicare UPIN