Healthcare Provider Details

I. General information

NPI: 1184698938
Provider Name (Legal Business Name): HOWARD J STANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 HWY 96 E MAIL STOP 32300A
WHITE BEAR LAKE MN
55110-7693
US

IV. Provider business mailing address

8100 34TH AVE S 21110Q
BLOOMINGTON MN
55425-1672
US

V. Phone/Fax

Practice location:
  • Phone: 651-653-2100
  • Fax: 651-653-2111
Mailing address:
  • Phone: 952-883-7961
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25320
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: