Healthcare Provider Details

I. General information

NPI: 1336272517
Provider Name (Legal Business Name): STEPHEN EDWARD PANETTA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2768 SUPERIOR DRIVE NW
ROCHESTER MN
55901
US

IV. Provider business mailing address

2768 SUPERIOR DR NW
ROCHESTER MN
55901-3063
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-1053
  • Fax: 507-282-1384
Mailing address:
  • Phone: 507-282-1053
  • Fax: 507-282-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number479
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: