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NPI Code Detail

MEDICARE: MR. STEVEN PETER DAFFINRUD MA LP

MEDICARE: MR. STEVEN PETER DAFFINRUD MA LP
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
1103T00000XPsychologistLP3707MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13041301OTHERMNBHP
2625T442OTHERUBH
3S01906459OTHERMMSI
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5314K4DAOTHERMNBCBS BLUE PLUS COMPCARE
6116812OTHERMNU CARE

General Provider Information

NPI Number : 1801878426
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEVEN PETER DAFFINRUD MA LP
Provider Business Mailing Address
First Line : 600 25TH AVE S
Second Line : ROOSEVELT OFFICE PARK SUITE 109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Provider Business Practice Location Address
First Line : 600 25TH AVE S
Second Line : ROOSEVELT OFFICE PARK SUITE 109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 07/08/2007

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