Individual
STEPHEN M BOCKHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
512 SKYLINE BLVD STE 1, CLOQUET, MN 55720-1199
(218) 879-4641
Mailing address
512 SKYLINE BLVD STE 1, CLOQUET, MN 55720-1199
(218) 879-4641
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49675
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174732952
MEDICA
—
01
—
16P73BO
BCBS
MN
05
—
857913100
—
MN
01
—
P00436607
RRMEDICARE PTAN
—
Enumeration date
05/21/2007
Last updated
12/27/2023
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