Provider Demographics
NPI:1124053285
Name:STEEN, PRESTON D (MD)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:D
Last Name:STEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 4TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0001
Mailing Address - Country:US
Mailing Address - Phone:701-234-2397
Mailing Address - Fax:701-234-3386
Practice Address - Street 1:820 4TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58122-0001
Practice Address - Country:US
Practice Address - Phone:701-234-2397
Practice Address - Fax:701-234-3386
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5967207RX0202X
MN34155207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN781705300Medicaid
896042OtherPREFERRED ONE
ND16543Medicaid
HP11504OtherHEALTHPARTNERS
0C283STOtherMNBC
3619886OtherMEDICA
NDN10317Medicaid
10317OtherNDBC
10317OtherNDBC
896042OtherPREFERRED ONE