Provider Demographics
NPI:1861479370
Name:BATTISTA, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BATTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6405 FRANCE AVENUE S
Mailing Address - Street 2:STE W200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-924-9005
Mailing Address - Fax:952-924-0330
Practice Address - Street 1:6405 FRANCE AVENUE S
Practice Address - Street 2:STE W200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-924-9005
Practice Address - Fax:952-924-0330
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN34748207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE96373Medicare UPIN