MEDICARE: STEADY STATE MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	1782	MN

General Provider Information

NPI Number	:	1104145978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEADY STATE MEDICINE, LLC

Provider Business Mailing Address
First Line	:	4001 STINSON BLVD STE 403
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55421-3424
Country	:	US
Telephone Number	:	612-767-5966
Fax Number	:	612-706-9617

Provider Business Practice Location Address
First Line	:	4001 STINSON BLVD STE 403
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55421-3424
Country	:	US
Telephone Number	:	612-767-5966
Fax Number	:	612-706-9617

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GERALD R WERTH
Credential	:	MD PHD
Telephone Number	:	612-767-5966

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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