Healthcare Provider Details

I. General information

NPI: 1508981333
Provider Name (Legal Business Name): STEVEN JOHN SUTHERLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EAST 3RD STREET ESESNTIA HEALTH-DULUTH CLINIC
DULUTH MN
55805
US

IV. Provider business mailing address

400 EAST 3RD STREET ESSENTIA HEALTH-DULUTH CLINIC
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-1186
  • Fax: 218-728-4404
Mailing address:
  • Phone: 218-786-8364
  • Fax: 218-728-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number33578
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39439
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: