Provider Demographics
NPI:1437241312
Name:MANN, STEPHEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:480 OSBORNE RD NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2773
Mailing Address - Country:US
Mailing Address - Phone:763-786-1620
Mailing Address - Fax:763-780-3099
Practice Address - Street 1:480 OSBORNE RD NE
Practice Address - Street 2:SUITE 220
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2773
Practice Address - Country:US
Practice Address - Phone:763-786-1620
Practice Address - Fax:763-780-3099
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38246207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN909019300Medicaid
MNHP17750OtherHEALTH PARTNERS
MN3600800OtherSELECT CARE
MN3600800OtherMEDICA
MN7K191MAOtherBLUE CROSS BLUE SHIELD
MN109519OtherUCARE
MN963001008878OtherPREFERRED ONE
MN410729979OtherCOMMERCIAL
MNHP17750OtherHEALTH PARTNERS
MNF74523Medicare UPIN