Organization
YOURPATH CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN MICHAEL DELISI MD (PRESIDENT)
(612) 699-7778
Entity
Organization
Contact information
Practice address
700 RAYMOND AVE STE 130, SAINT PAUL, MN 55114-1778
(612) 895-1510
Mailing address
700 RAYMOND AVE STE 130, SAINT PAUL, MN 55114-1778
(612) 895-1510
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205020005
—
MN
05
—
1528063765
—
MN
05
—
1528063765
—
WI
05
—
1538693247
—
MN
05
—
1669732103
—
MN
05
—
1679915706
—
MN
Enumeration date
05/30/2023
Last updated
05/30/2023
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