MEDICARE: DR. STEPHEN DENNIS NORTHROP D.D.S., 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	1223G0001X	General Practice Dentistry	29638	CA
2	2084N0400X	Neurology Physician	036087093	IL
3	2084N0400X	Neurology Physician	38583020	WI
4	2084N0400X	Neurology Physician	81051	FL

General Provider Information

NPI Number	:	1164732525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN DENNIS NORTHROP D.D.S., M.D.

Provider Business Mailing Address
First Line	:	3624 E 1ST ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55804-1800
Country	:	US
Telephone Number	:	218-349-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	12865 W AUDREY AVE
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60087-3444
Country	:	US
Telephone Number	:	218-349-7058
Fax Number	:

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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