Healthcare Provider Details

I. General information

NPI: 1982670766
Provider Name (Legal Business Name): STEPHEN C RIENDL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST MC 11102H
ST PAUL MN
55101-2502
US

IV. Provider business mailing address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3462
  • Fax: 651-254-1603
Mailing address:
  • Phone: 651-254-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27188
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number46063
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: