Provider Demographics
NPI:1013093004
Name:MOSER, STACI (DO)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:
Last Name:MOSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NICOLLET MALL # 260
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2542
Mailing Address - Country:US
Mailing Address - Phone:952-977-0700
Mailing Address - Fax:952-977-1977
Practice Address - Street 1:1000 NICOLLET MALL # 260
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2542
Practice Address - Country:US
Practice Address - Phone:952-977-0700
Practice Address - Fax:952-977-1977
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN051044100Medicaid
1032683OtherPREFERRED ONE/URGENT CARE
106789OtherUCARE/URGENT CARE
66-08691OtherMEDICA/URGENT CARE
HP54874OtherHEALTHPARTNERS/URGENT CAR
IA0596379Medicaid
634T4MOOtherBCBS/URGENT CARE
WI34680400Medicaid
WI34680400Medicaid
080014341Medicare ID - Type Unspecified