Healthcare Provider Details

I. General information

NPI: 1194716043
Provider Name (Legal Business Name): STEVEN N HONEBRINK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 NORTHWAY DR
SAINT CLOUD MN
56303-4478
US

IV. Provider business mailing address

1520 NORTHWAY DR
SAINT CLOUD MN
56303-4478
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-1775
  • Fax: 320-240-3131
Mailing address:
  • Phone: 320-251-1775
  • Fax: 320-240-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25012
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: