Healthcare Provider Details

I. General information

NPI: 1720024409
Provider Name (Legal Business Name): DAVID D STUART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE S1
MINNEAPOLIS MN
55415-1829
US

IV. Provider business mailing address

701 PARK AVE MAIL CODE G5
MINNEAPOLIS MN
55415-1829
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-6800
  • Fax: 612-904-4322
Mailing address:
  • Phone: 612-873-7381
  • Fax: 612-904-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number19242
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: