Provider Demographics
NPI:1336409507
Name:STEPAN, REBECCA KAY (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:STEPAN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:CENTRACARE HEALTH SAUK CENTER CLINIC
Mailing Address - Street 2:425 ELM ST N
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1010
Mailing Address - Country:US
Mailing Address - Phone:320-352-6591
Mailing Address - Fax:320-352-5164
Practice Address - Street 1:CENTRACARE HEALTH SAUK CENTER CLINIC
Practice Address - Street 2:425 ELM ST N
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1010
Practice Address - Country:US
Practice Address - Phone:320-352-6591
Practice Address - Fax:320-352-5164
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2023-03-14
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN57328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1336409507OtherBCBS OF MN
MN1336409507Medicaid