Healthcare Provider Details

I. General information

NPI: 1356419378
Provider Name (Legal Business Name): STEVEN L SENICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13060 ISLE DR
BAXTER MN
56425-8331
US

IV. Provider business mailing address

13060 ISLE DR
BAXTER MN
56425-8331
US

V. Phone/Fax

Practice location:
  • Phone: 218-855-5473
  • Fax: 218-454-5936
Mailing address:
  • Phone: 218-855-5473
  • Fax: 218-454-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0369092176
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56720
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: