Provider Demographics
NPI:1770593089
Name:DITTES, STEVEN MARK (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:DITTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 FRANCE AVE S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2129
Mailing Address - Country:US
Mailing Address - Phone:952-920-2070
Mailing Address - Fax:952-920-7444
Practice Address - Street 1:6363 FRANCE AVE S
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2129
Practice Address - Country:US
Practice Address - Phone:952-920-2070
Practice Address - Fax:952-920-7444
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN027837207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN068700600Medicaid
MN0734002OtherPREFERRED ONE
MN110161177OtherRAILROAD MEDICARE
MNHP13170OtherHEALTHPARTNERS
MN9290114OtherMEDICA
MN101033C027OtherUCARE
WI31577300OtherWISCONSIN MEDICAL ASSISTA
MN21899OtherFHP PROVIDER NUMBER
MN34Q16DIOtherBLUE CROSS BLUE SHIELD
MN9219373OtherPHP PROVIDER NUMBER
MNHP13170OtherHEALTHPARTNERS
MN101033C027OtherUCARE
MNE40637Medicare UPIN