Provider Demographics
NPI:1609949759
Name:VERSTEEG, SUE ANN (DO)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:VERSTEEG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:VER STEEG
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:410 CHURCH ST SE
Mailing Address - Street 2:BOYNTON HEALTH SERVICE, UNIVERSITY OF MINNESOTA
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0340
Mailing Address - Country:US
Mailing Address - Phone:612-625-8400
Mailing Address - Fax:612-625-1434
Practice Address - Street 1:410 CHURCH ST SE
Practice Address - Street 2:BOYNTON HEALTH SERVICE, UNIVERSITY OF MINNESOTA
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0340
Practice Address - Country:US
Practice Address - Phone:612-625-8400
Practice Address - Fax:612-625-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF14121Medicare UPIN