MEDICARE: STEVEN W HALLSTROM 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
1	207Q00000X	Family Medicine Physician	24784	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1780690735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN W HALLSTROM MD

Provider Business Mailing Address
First Line	:	2025 SLOAN PL STE 35
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2092
Country	:	US
Telephone Number	:	651-772-1572
Fax Number	:	651-772-1889

Provider Business Practice Location Address
First Line	:	2601 CENTENNIAL DR STE 100
Second Line	:
City	:	NORTH ST PAUL
State	:	MN
Zip	:	55109-3087
Country	:	US
Telephone Number	:	651-777-7414
Fax Number	:	651-748-5839

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	04/22/2019

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