Provider Demographics
NPI:1275584815
Name:SJOBERG, STACY A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:SJOBERG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:A
Other - Last Name:STREGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1665
Mailing Address - Country:US
Mailing Address - Phone:218-546-5108
Mailing Address - Fax:218-546-5736
Practice Address - Street 1:1 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1665
Practice Address - Country:US
Practice Address - Phone:218-546-5108
Practice Address - Fax:218-546-5736
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47570207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN014957800Medicaid
MN310G3SJOtherBLUE CROSS & BLUE SHIELD
MNP00235993OtherTRAVELERS MEDICARE
MN0801285OtherMEDICA
MN310G3SJOtherBLUE CROSS & BLUE SHIELD
MN014957800Medicaid