Healthcare Provider Details

I. General information

NPI: 1578683462
Provider Name (Legal Business Name): STEPHEN LEE FRIDINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 ROSEMILL LN
WOODBURY MN
55129-5291
US

IV. Provider business mailing address

2807 ROSEMILL LN
WOODBURY MN
55129-5291
US

V. Phone/Fax

Practice location:
  • Phone: 612-965-8700
  • Fax:
Mailing address:
  • Phone: 612-965-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number3620
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: