Basic Information
Provider Information
NPI: 1588982482
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEGEMAN
FirstName: ALEXANDER
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1919 UNIVERSITY AVE W
Address2: #200
City: SAINT PAUL
State: MN
PostalCode: 551043453
CountryCode: US
TelephoneNumber: 6512667999
FaxNumber: 6512667850
Practice Location
Address1: 2120 FORD PKWY
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551161863
CountryCode: US
TelephoneNumber: 6512419600
FaxNumber: 6512419593
Other Information
ProviderEnumerationDate: 05/17/2010
LastUpdateDate: 06/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X58228MNY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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