| Organization Name: | STILLWATER MEDICAL GROUP |
| NPI Number: | 1598099772 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIRK NYBAKKEN (DIRECTOR OF FINANCE) |
| Mailing Address: | 5815 Norell Ave N Oak Park Heights |
| State: | MN US |
| Postal Code: | 550821766 |
| Phone Number: | 6514391234 |
| Fax Number: | 6512753325 |
| NPI Enumeration Date: | 09/22/2009 |
| NPI Last Update Date: | 01/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 238 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |