Healthcare Provider Details

I. General information

NPI: 1104145978
Provider Name (Legal Business Name): STEADY STATE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 STINSON BLVD STE 403
MINNEAPOLIS MN
55421-3424
US

IV. Provider business mailing address

4001 STINSON BLVD STE 403
MINNEAPOLIS MN
55421-3424
US

V. Phone/Fax

Practice location:
  • Phone: 612-767-5966
  • Fax: 612-706-9617
Mailing address:
  • Phone: 612-767-5966
  • Fax: 612-706-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number1782
License Number StateMN

VIII. Authorized Official

Name: DR. GERALD R WERTH
Title or Position: OWNER
Credential: MD PHD
Phone: 612-767-5966