Provider Demographics
NPI:1336272517
Name:PANETTA, STEPHEN EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:PANETTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2768 SUPERIOR DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3063
Mailing Address - Country:US
Mailing Address - Phone:507-282-1053
Mailing Address - Fax:507-282-1384
Practice Address - Street 1:2768 SUPERIOR DRIVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:507-282-1053
Practice Address - Fax:507-282-1384
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN479213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU37924Medicare UPIN
MN480000166Medicare ID - Type Unspecified
MN1068360002Medicare NSC