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General NPI Number Information
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NPI Number | 1992800817
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Entity Type | Individual
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Provider Name | DR. STEPHEN BLYTHE
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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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 SUITE # 502
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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 | 651-248-2113
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Fax |
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Provider Business Mailing Address
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Address Line | 8680 KIMBRO LN N
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City | STILLWATER
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State | MN
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Zip | 55082-4507
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Country | US
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Telephone |
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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 | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 29961
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License Number State | MN
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