Provider Demographics
NPI:1841455383
Name:PENG, STEPHANIE LEE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:PENG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:15450 HIGHWAY 7
Mailing Address - Street 2:STE 225
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3522
Mailing Address - Country:US
Mailing Address - Phone:763-999-4170
Mailing Address - Fax:763-951-0941
Practice Address - Street 1:15450 HIGHWAY 7
Practice Address - Street 2:STE 225
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3522
Practice Address - Country:US
Practice Address - Phone:763-999-4170
Practice Address - Fax:763-951-0941
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2022-12-14
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Provider Licenses
StateLicense IDTaxonomies
MN57866208200000X
WAML600208082086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery