Healthcare Provider Details

I. General information

NPI: 1275767865
Provider Name (Legal Business Name): KEVIN L. STEVENSON, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 SAINT PETER ST SUITE 230
SAINT PAUL MN
55102-1001
US

IV. Provider business mailing address

514 SAINT PETER ST SUITE 230
SAINT PAUL MN
55102-1001
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-0887
  • Fax: 651-379-0889
Mailing address:
  • Phone: 651-379-0887
  • Fax: 651-379-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN L. STEVENSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 651-379-0887