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Organization
STILLWATER MEDICAL GROUP
Active
Organization
STILLWATER MEDICAL GROUP
Active
Other names
Stillwater Medical Group, PA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK NYBAKKEN (DIRECTOR OF FINANCE)
(651) 275-3302
Entity
Organization
Contact information
Practice address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 351-0827
Mailing address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 351-0827
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
208600000X
Surgery Physician
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
231H00000X
Audiologist
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32834400
—
WI
05
—
32882900
—
WI
01
—
5439670003
MEDICARE NSB
MN
05
—
802128700
—
MN
Enumeration date
10/13/2005
Last updated
10/18/2011
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