Healthcare Provider Details

I. General information

NPI: 1396781696
Provider Name (Legal Business Name): STEPHEN BRUCE SUNDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNIVERSITY AVE E
SAINT PAUL MN
55101-2507
US

IV. Provider business mailing address

200 UNIVERSITY AVE E
SAINT PAUL MN
55101-2507
US

V. Phone/Fax

Practice location:
  • Phone: 651-602-3262
  • Fax: 651-312-3188
Mailing address:
  • Phone: 651-291-2848
  • Fax: 651-602-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25520
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: