Healthcare Provider Details

I. General information

NPI: 1104872092
Provider Name (Legal Business Name): KARL EDWIN STIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WEST CLAIREMONT AVENUE
EAU CLAIRE WI
54701
US

IV. Provider business mailing address

2715 WEST FRANK STREET
EAU CLAIRE WI
54703
US

V. Phone/Fax

Practice location:
  • Phone: 715-839-4151
  • Fax:
Mailing address:
  • Phone: 715-834-5511
  • Fax: 715-834-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number47108
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number47096
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number47108
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number47096
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47108
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47096
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number47096
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number47108
License Number StateMN
# 9
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number47108
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number47096
License Number StateWI
# 11
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number47108
License Number StateMN
# 12
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number47096
License Number StateWI
# 13
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number47096
License Number StateWI
# 14
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number47108
License Number StateMN
# 15
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number47096
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: