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General NPI Number Information
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NPI Number | 1841283843
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Entity Type | Individual
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Provider Name | STEPHEN L LISTON MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 347 SMITH AVE N STE 602
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City | SAINT PAUL
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State | MN
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Zip | 55102-2387
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Country | US
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Telephone | 651-227-0821
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Fax | 651-297-6597
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Provider Business Mailing Address
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Address Line | 2211 PARK AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-3711
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Country | US
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Telephone | 612-871-1144
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Fax | 612-871-2012
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 23911
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License Number State | MN
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