Provider Demographics
NPI:1922179456
Name:ANDERSON-HERMANN, STEVEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:ANDERSON-HERMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:ALAN
Other - Last Name:HERMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:410 CHURCH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0340
Mailing Address - Country:US
Mailing Address - Phone:612-624-1444
Mailing Address - Fax:612-625-7155
Practice Address - Street 1:410 CHURCH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0340
Practice Address - Country:US
Practice Address - Phone:612-624-1444
Practice Address - Fax:612-625-7155
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN323002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE75234Medicare UPIN