Healthcare Provider Details

I. General information

NPI: 1992933956
Provider Name (Legal Business Name): STEVEN GENE FRIEDENBERG DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 10/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 FITCH AVE 295T AS/VM
SAINT PAUL MN
55108-6009
US

IV. Provider business mailing address

1988 FITCH AVE 295T AS/VM
SAINT PAUL MN
55108-6009
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-7744
  • Fax:
Mailing address:
  • Phone: 612-625-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number17738
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number7721
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: