Provider Demographics
NPI:1275512261
Name:PUTZIER, STEPHANIE W (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:W
Last Name:PUTZIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:160 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-9338
Mailing Address - Country:US
Mailing Address - Phone:507-380-3644
Mailing Address - Fax:507-345-1553
Practice Address - Street 1:3530 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8166
Practice Address - Country:US
Practice Address - Phone:651-714-0200
Practice Address - Fax:651-714-0201
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1966132OtherAMERICAS PPO
MN958583400Medicaid
MN0401916OtherMEDICA
MN121151OtherUCARE
MNHP25864OtherHEALTH PARTNERS
410849339 56001 C077OtherCHAMPUS
MNNA2951023855OtherPREFERRED ONE
110103558OtherRR MEDICARE
MN1M944PUOtherBCBS
MN121151OtherUCARE
MN119001061Medicare ID - Type Unspecified