Provider Demographics
NPI:1184698938
Name:STANG, HOWARD J (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:STANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:1430 HWY 96 E
Practice Address - Street 2:MAIL STOP 32300A
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-7693
Practice Address - Country:US
Practice Address - Phone:651-653-2100
Practice Address - Fax:651-653-2111
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN25320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN961582200Medicaid
MN370002081Medicare ID - Type Unspecified
MN961582200Medicaid