Provider Demographics
NPI:1629267497
Name:PRATT, STEVEN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ERIC
Last Name:PRATT
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 1:761 COUNTRY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-5489
Mailing Address - Country:US
Mailing Address - Phone:612-790-8719
Mailing Address - Fax:
Practice Address - Street 1:761 COUNTRY LAKES DR
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-5489
Practice Address - Country:US
Practice Address - Phone:612-790-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF29935Medicare UPIN