Provider Demographics
NPI:1497978241
Name:NORTHSTAR NEUROLOGICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:NORTHSTAR NEUROLOGICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TROBIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-416-1400
Mailing Address - Street 1:12000 ELM CREEK BLVD N
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7073
Mailing Address - Country:US
Mailing Address - Phone:763-416-1400
Mailing Address - Fax:763-416-0022
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 330
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-416-1400
Practice Address - Fax:763-416-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327762084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2072293Medicaid
MNC-45999Medicare UPIN