Healthcare Provider Details

I. General information

NPI: 1124527718
Provider Name (Legal Business Name): STALZER ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14525 HIGHWAY 7 STE 180
MINNETONKA MN
55345-3742
US

IV. Provider business mailing address

5040 CEDAR AVE S
MINNEAPOLIS MN
55417-1238
US

V. Phone/Fax

Practice location:
  • Phone: 612-547-5757
  • Fax:
Mailing address:
  • Phone: 612-246-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY STALZER
Title or Position: OWNER
Credential:
Phone: 612-246-6519