Healthcare Provider Details

I. General information

NPI: 1124053285
Provider Name (Legal Business Name): PRESTON D STEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 4TH STREET NORTH
FARGO ND
58122-0001
US

IV. Provider business mailing address

820 4TH STREET NORTH
FARGO ND
58122-0001
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2397
  • Fax: 701-234-3386
Mailing address:
  • Phone: 701-234-2397
  • Fax: 701-234-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number5967
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number34155
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: