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General NPI Number Information
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NPI Number | 1639418759
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Entity Type | Individual
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Provider Name | KEVIN STOLTZ AU.D.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 6001 EGAN DR SUITE 160
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City | SAVAGE
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State | MN
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Zip | 55378-4921
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Country | US
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Telephone | 612-564-5686
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 DEERWOOD TRL
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City | EAGAN
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State | MN
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Zip | 55122-1887
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Country | US
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Telephone | 612-308-6761
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 8355
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License Number State | MN
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