Provider Demographics
NPI:1932302858
Name:QUANBECK, STANLEY DWIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:DWIGHT
Last Name:QUANBECK
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 1:20607 KEARNEY PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6713
Mailing Address - Country:US
Mailing Address - Phone:612-644-0948
Mailing Address - Fax:
Practice Address - Street 1:970 PICKETT ST N
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:MN
Practice Address - Zip Code:55003-1489
Practice Address - Country:US
Practice Address - Phone:651-779-2700
Practice Address - Fax:651-351-3619
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16809173000000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered173000000XOther Service ProvidersLegal Medicine
Not Answered320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKI 44985Medicare UPIN