MEDICARE: DR. STEFAN HAKON POMRENKE 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	390200000X	Student in an Organized Health Care Education/Training Program		MN
2	207Q00000X	Family Medicine Physician	52333	MN

General Provider Information

NPI Number	:	1881860567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN HAKON POMRENKE M.D.

Provider Business Mailing Address
First Line	:	387 PARK AVE S FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-8810
Country	:	US
Telephone Number	:	888-564-5250
Fax Number	:	646-350-0525

Provider Business Practice Location Address
First Line	:	387 PARK AVE S FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-8810
Country	:	US
Telephone Number	:	888-564-5250
Fax Number	:	646-350-0525

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

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	11/27/2024

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