Healthcare Provider Details

I. General information

NPI: 1255504080
Provider Name (Legal Business Name): SEAN PATRICK STOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 OAKDALE AVE N STE 401
ROBBINSDALE MN
55422-2986
US

IV. Provider business mailing address

3366 OAKDALE AVE N STE 401
ROBBINSDALE MN
55422-2986
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-2940
  • Fax: 763-520-2943
Mailing address:
  • Phone: 763-520-2940
  • Fax: 763-520-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number281190
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number55796
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036.140573
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55796
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: