Provider Demographics
NPI:1548241706
Name:SHU, STEVEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:SHU
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:5502 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3508
Mailing Address - Country:US
Mailing Address - Phone:763-287-6500
Mailing Address - Fax:763-287-6544
Practice Address - Street 1:5502 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3508
Practice Address - Country:US
Practice Address - Phone:763-287-6500
Practice Address - Fax:763-287-6544
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN44484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH09419Medicare UPIN