Provider Demographics
NPI:1225187255
Name:MARK P STESIN MD PA
Entity Type:Organization
Organization Name:MARK P STESIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:STESIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-520-5876
Mailing Address - Street 1:3366 OAKDALE AVE N
Mailing Address - Street 2:SUITE 408
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2948
Mailing Address - Country:US
Mailing Address - Phone:763-520-5876
Mailing Address - Fax:763-520-1703
Practice Address - Street 1:3366 OAKDALE AVE N
Practice Address - Street 2:SUITE 408
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-520-5876
Practice Address - Fax:763-520-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1250207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16877STOtherCOMPREHENSIVE CARE
MNDD1669OtherRAILROAD MEDICARE
MN203001OtherPREFERRED ONE GROUP CODE
MN16877STOtherBLUE CROSS GROUP CODE
MN16877STOtherBLUE CROSS GROUP CODE
MNDD1669OtherRAILROAD MEDICARE
MNCO1280Medicare ID - Type Unspecified