Provider Demographics
NPI:1578683462
Name:FRIDINGER, STEPHEN LEE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:FRIDINGER
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 1:2807 ROSEMILL LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-5291
Mailing Address - Country:US
Mailing Address - Phone:612-965-8700
Mailing Address - Fax:
Practice Address - Street 1:2807 ROSEMILL LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-5291
Practice Address - Country:US
Practice Address - Phone:612-965-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3620111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN375T8FROtherBC-BS
MN096293700Medicaid
MN350002971Medicare ID - Type Unspecified
MN375T8FROtherBC-BS