Provider Demographics
NPI:1518947936
Name:STOLTENBERG, HEIDI GAYE (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:GAYE
Last Name:STOLTENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-7000
Mailing Address - Fax:641-428-6383
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-428-7000
Practice Address - Fax:641-428-6383
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN46117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118425300Medicaid
H87468Medicare UPIN
MN118425300Medicaid