Healthcare Provider Details

I. General information

NPI: 1003830613
Provider Name (Legal Business Name): THOMAS STEALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S SUITE 400
EDINA MN
55435-2131
US

IV. Provider business mailing address

6545 FRANCE AVE S SUITE 400
EDINA MN
55435-2131
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-9191
  • Fax: 952-920-0232
Mailing address:
  • Phone: 952-920-9191
  • Fax: 952-920-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23647
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: