MEDICARE: DR. STEVEN ANDREW ARCHIBALD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	036-104696	IL
2	2085R0202X	Diagnostic Radiology Physician	35262	AZ
3	2085R0202X	Diagnostic Radiology Physician	G87697	CA
4	2085R0202X	Diagnostic Radiology Physician	M9531	ID
5	2085R0202X	Diagnostic Radiology Physician	01061626A	IN
6	2085R0202X	Diagnostic Radiology Physician	4301087103	MI
7	2085R0202X	Diagnostic Radiology Physician	1167	MN
8	2085R0202X	Diagnostic Radiology Physician	TM2006-0017	NM
9	2085R0202X	Diagnostic Radiology Physician	239553	NY
10	2085R0202X	Diagnostic Radiology Physician	2006-00472	NC
11	2085R0202X	Diagnostic Radiology Physician	25.000057	OH
12	2085R0202X	Diagnostic Radiology Physician	MD428455	PA

General Provider Information

NPI Number	:	1083657134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ANDREW ARCHIBALD M.D.

Provider Business Mailing Address
First Line	:	11995 SINGLETREE LN
Second Line	:	SUITE 500
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-5347
Country	:	US
Telephone Number	:	952-595-1301
Fax Number	:	612-294-4903

Provider Business Practice Location Address
First Line	:	401 E. ONTARIO ST.
Second Line	:	#4601
City	:	CHICAGO
State	:	IL
Zip	:	60611-4444
Country	:	US
Telephone Number	:	952-595-1100
Fax Number	:	612-294-4903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	06/24/2015

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