Healthcare Provider Details

I. General information

NPI: 1235190786
Provider Name (Legal Business Name): DAVID R VANDERSTEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE #550
MINNEAPOLIS MN
55404-4289
US

IV. Provider business mailing address

2530 CHICAGO AVE #550
MINNEAPOLIS MN
55404-4289
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-8000
  • Fax: 612-813-8005
Mailing address:
  • Phone: 612-813-8000
  • Fax: 612-813-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number39449
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberW3199
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number036152612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: