Provider Demographics
NPI:1265545784
Name:DAHL, STEPHANIE K (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:DAHL
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 1:6565 FRANCE AVE S STE 400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2137
Mailing Address - Country:US
Mailing Address - Phone:952-225-1630
Mailing Address - Fax:952-225-1609
Practice Address - Street 1:6565 FRANCE AVE S STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:952-225-1630
Practice Address - Fax:952-225-1609
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9584207V00000X
MN49394207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0704458OtherMEDICA
2367430OtherAMERICAS PPO
MN265441500Medicaid
457G7DAOtherMN BCBS
ND13531Medicaid
1044606OtherPREFERREDONE
HP55620OtherHEALTHPARTNERS
25831OtherND BCBS
25831OtherND BCBS
ND13531Medicaid