Provider Demographics
NPI:1992758833
Name:KURISKO, STANLEY DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:DOUGLAS
Last Name:KURISKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN439812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN253803OtherMIDLANDS CHOICE INC
MN1992758833OtherDAKOTA CARE
MN709485000Medicaid
IA0570481Medicaid
MN141092OtherUCARE
WI34402500Medicaid
MN1029757OtherPREFERRED ONE
MN1518058OtherAMERICA'S PPO
MNHP34107OtherHEALTHPARTNERS
MN53G60KUOtherBLUE CROSS
MNH53334Medicare UPIN
MN300002588Medicare PIN
MNHP34107OtherHEALTHPARTNERS
MN1518058OtherAMERICA'S PPO
MN300002586Medicare PIN
MN141092OtherUCARE