Healthcare Provider Details

I. General information

NPI: 1558770297
Provider Name (Legal Business Name): CHRISTOPHER STEVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 QUARRY RIDGE PL NW APT 115
ROCHESTER MN
55901-0819
US

IV. Provider business mailing address

1728 QUARRY RIDGE PL NW APT 115
ROCHESTER MN
55901-0819
US

V. Phone/Fax

Practice location:
  • Phone: 507-202-6705
  • Fax:
Mailing address:
  • Phone: 507-202-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number57651
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: