Provider Demographics
NPI:1376593517
Name:FOLTZ, STEVEN L (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:L
Last Name:FOLTZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2742
Mailing Address - Country:US
Mailing Address - Phone:218-249-6822
Mailing Address - Fax:218-249-6828
Practice Address - Street 1:4702 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2742
Practice Address - Country:US
Practice Address - Phone:218-249-6822
Practice Address - Fax:218-249-6828
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN019585500Medicaid
MNS47912Medicare UPIN
MN019585500Medicaid