Provider Demographics
NPI:1801837349
Name:STEELY, JOHN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WAYNE
Last Name:STEELY
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 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN272032085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN23016OtherAMERICA'S PPO
MN239259OtherMIDLANDS CHOICE INC
MN342SOSTOtherBLUE CROSS
MN100716OtherUCARE
WI300011436OtherRAILROAD MEDICARE WI
MN381580300Medicaid
IA1907667Medicaid
ND23699OtherBLUE CROSS BLUE SHIELD
MN496O9STOtherBLUE CROSS
MN300131999OtherRAILROAD MEDICARE MN
MN1016653OtherPREFERRED ONE
MNHP14473OtherHEALTHPARTNERS
MN1801837349OtherDAKOTA CARE
WI31896600Medicaid
ND23699Medicare PIN
WI001756135Medicare PIN
MNHP14473OtherHEALTHPARTNERS
MN239259OtherMIDLANDS CHOICE INC
IA1907667Medicaid
MN300003433Medicare PIN
MN342SOSTOtherBLUE CROSS