Provider Demographics
NPI:1770587180
Name:STOCKENSTROM, TROND A (MD)
Entity type:Individual
Prefix:DR
First Name:TROND
Middle Name:A
Last Name:STOCKENSTROM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:STE 2000
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2708
Mailing Address - Country:US
Mailing Address - Phone:612-338-4861
Mailing Address - Fax:612-333-8306
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:STE 2000
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2708
Practice Address - Country:US
Practice Address - Phone:612-338-4861
Practice Address - Fax:612-333-8306
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN36846207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0800691OtherSELECTCARE
MN1021630001OtherADMINISTAR FEDERAL NE
MN47G42DTOtherBLUE SHIELD
MN0800691OtherMEDICA CHOICE
MN0800038OtherMEDICA PRIMARY
MN962531028814OtherPREFERRED ONE
MNHP34123OtherHEALTHPARTNERS
MN200002101436OtherMETROPOLITAN HEALTH PLAN
MN1021630002OtherADMINISTAR FEDERAL DT
MN200002101436OtherMETROPOLITAN HEALTH PLAN