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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