Healthcare Provider Details

I. General information

NPI: 1053949859
Provider Name (Legal Business Name): LAURA STOLBROCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA STOLP MD

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 FORD PKWY STE 200
SAINT PAUL MN
55116-3412
US

IV. Provider business mailing address

2270 FORD PKWY STE 200
SAINT PAUL MN
55116-3412
US

V. Phone/Fax

Practice location:
  • Phone: 855-324-7843
  • Fax:
Mailing address:
  • Phone: 855-324-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77369
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77369
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: