Provider Demographics
NPI:1275600231
Name:SONNESYN, STEVEN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILLIAM
Last Name:SONNESYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11676 WAYZATA BOULEVARD
Mailing Address - Street 2:INFECTIOUS DISEASE CONSULTANTS PA
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2009
Mailing Address - Country:US
Mailing Address - Phone:952-746-8360
Mailing Address - Fax:952-746-8368
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:952-746-8360
Practice Address - Fax:952-746-8368
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN34084207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN440000823OtherRAILROAD MEDICARE
MN074865000Medicaid
MN2T793S0OtherBCBS OF MN
MN9228651OtherMEDICA
MN2T793S0OtherBCBS OF MN
MN440000074Medicare ID - Type Unspecified