Provider Demographics
NPI:1497830467
Name:MILES, STEVEN HAVERSTOCK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:HAVERSTOCK
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVENUE (P7.730)
Mailing Address - Street 2:MEDICINE CLINIC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1829
Mailing Address - Country:US
Mailing Address - Phone:612-873-2300
Mailing Address - Fax:612-904-4261
Practice Address - Street 1:701 PARK AVENUE (P7.730)
Practice Address - Street 2:MEDICINE CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1829
Practice Address - Country:US
Practice Address - Phone:612-873-2300
Practice Address - Fax:612-904-4261
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
108952OtherUCARE
WI31561900Medicaid
MN580062500Medicaid
IA0551531Medicaid
244A4MIOtherBLUE CROSS BLUE SHIELD
1031723OtherPREFERRED ONE
1685542OtherARAZ
04-00123OtherMEDICA PRIMARY
04-04710OtherMEDICA CHOICE
HP17903OtherHEALTH PARTNERS
110008367Medicare ID - Type Unspecified
MN580062500Medicaid
110233617Medicare ID - Type UnspecifiedRAILROAD MEDICARE