Healthcare Provider Details

I. General information

NPI: 1215914411
Provider Name (Legal Business Name): STEPHANIE D BOYLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-629-7625
  • Fax: 612-629-7280
Mailing address:
  • Phone: 612-629-7625
  • Fax: 612-629-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number30890
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: