Individual
PHILLIP C HOVERSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9055 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5841
(763) 780-9155
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
22873
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
926705100
—
MN
Enumeration date
04/20/2006
Last updated
11/10/2011
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