Provider Demographics
NPI:1609134782
Name:STEVERMER, MICHALENE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:MICHALENE
Middle Name:MARIE
Last Name:STEVERMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICHALENE
Other - Middle Name:MARIE
Other - Last Name:OTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:220 N 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1952
Mailing Address - Country:US
Mailing Address - Phone:218-249-7000
Mailing Address - Fax:218-249-7050
Practice Address - Street 1:220 N 6TH AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1952
Practice Address - Country:US
Practice Address - Phone:218-249-7000
Practice Address - Fax:218-249-7050
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN579102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry