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NPI Code Detail

MEDICARE: STEPHEN M DELISI MD

MEDICARE: STEPHEN M DELISI MD
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
12084A0401XAddiction Medicine (Psychiatry & Neurology) Physician48123MN
22084P0800XPsychiatry Physician46660WI
32084P0800XPsychiatry Physician48123MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528063765
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN M DELISI MD
Provider Business Mailing Address
First Line : 700 RAYMOND AVE STE 130
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1778
Country : US
Telephone Number : 612-699-7778
Fax Number :
Provider Business Practice Location Address
First Line : 700 RAYMOND AVE STE 130
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1778
Country : US
Telephone Number : 612-699-7778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 05/30/2023

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