Provider Demographics
NPI:1447424882
Name:STAVIG, CHRISTINA (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:STAVIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 HYLAND GREENS DR
Mailing Address - Street 2:PARK NICOLLET CLINIC - BLOOMINGTON
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3938
Mailing Address - Country:US
Mailing Address - Phone:952-993-2400
Mailing Address - Fax:952-993-2522
Practice Address - Street 1:5320 HYLAND GREENS DR
Practice Address - Street 2:PARK NICOLLET CLINIC - BLOOMINGTON
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-3938
Practice Address - Country:US
Practice Address - Phone:952-993-2400
Practice Address - Fax:952-993-2522
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50985207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program