Healthcare Provider Details

I. General information

NPI: 1730302217
Provider Name (Legal Business Name): STEVEN MORGEN STULC DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 37TH AVE N STE 150
PLYMOUTH MN
55446-3675
US

IV. Provider business mailing address

710 COMMERCE DR STE 200
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5201
  • Fax: 651-968-5904
Mailing address:
  • Phone: 651-968-5201
  • Fax: 651-968-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number50162
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: