Healthcare Provider Details

I. General information

NPI: 1184691362
Provider Name (Legal Business Name): STEVEN TIMOTHY TVEDTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 MOUNT NORMANDALE CURV
BLOOMINGTON MN
55437-1019
US

IV. Provider business mailing address

PO BOX 39478
EDINA MN
55439-0478
US

V. Phone/Fax

Practice location:
  • Phone: 952-921-0450
  • Fax: 952-835-0999
Mailing address:
  • Phone: 952-921-0450
  • Fax: 952-835-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23936
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: