Healthcare Provider Details

I. General information

NPI: 1730100959
Provider Name (Legal Business Name): RANDEL T STOLEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CONEY ST W
PERHAM MN
56573-2102
US

IV. Provider business mailing address

1000 CONEY ST W
PERHAM MN
56573-2102
US

V. Phone/Fax

Practice location:
  • Phone: 218-347-1200
  • Fax:
Mailing address:
  • Phone: 218-347-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1462
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35231
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: