Healthcare Provider Details

I. General information

NPI: 1891723078
Provider Name (Legal Business Name): STEVEN JAMES WAISBREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
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: 612-978-0218
  • Fax: 612-713-6765
Mailing address:
  • Phone: 612-978-0218
  • Fax: 612-713-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39606
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: