Provider Demographics
NPI:1891769279
Name:STECKLEIN, HILARY P (MD)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:P
Last Name:STECKLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 SEASONS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4402
Mailing Address - Country:US
Mailing Address - Phone:651-702-5300
Mailing Address - Fax:651-702-5305
Practice Address - Street 1:8450 SEASONS PARKWAY
Practice Address - Street 2:MAIL STOP 32900A
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4402
Practice Address - Country:US
Practice Address - Phone:651-702-5300
Practice Address - Fax:651-702-5305
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN227502300Medicaid
370001617Medicare ID - Type Unspecified
MN227502300Medicaid