Healthcare Provider Details

I. General information

NPI: 1124343314
Provider Name (Legal Business Name): STEVEN PAUL ROBAK CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 FRANCE AVE S SUITE 100
EDINA MN
55435-4202
US

IV. Provider business mailing address

7025 FRANCE AVE S SUITE 100
EDINA MN
55435-4202
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-7337
  • Fax: 952-927-8610
Mailing address:
  • Phone: 952-927-7337
  • Fax: 952-927-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR106666-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: