Healthcare Provider Details

I. General information

NPI: 1972501120
Provider Name (Legal Business Name): STEVEN PAUL HARTBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 HOSPITAL DR
WINDOM MN
56101-1287
US

IV. Provider business mailing address

PO BOX 249
WINDOM MN
56101-0249
US

V. Phone/Fax

Practice location:
  • Phone: 507-831-1422
  • Fax: 507-831-4783
Mailing address:
  • Phone: 507-831-1422
  • Fax: 507-831-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26241
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: