Active NPI
Stephen M Marchuk, MD
- Surgery Physician
- Mankato, MN
National Provider Identifier
1295765451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 37659
- Practice address
- 1230 E. Main Street
Mankato, MN 55002-8674 - Phone
- (507) 625-1811
- Fax
- (218) 263-1035
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 37659 | MN | Primary |
Addresses
Primary practice location
1230 E. Main Street
Mankato, MN 55002-8674
Mailing address
PO Box 8674 1230 E. Main Street
Mankato Clinic, LTD
Mankato, MN 55002-8674
Phone (507) 625-1811
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32386400 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37659 | MN | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1295765451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8674 1230 E. MAIN STREET",
"address_2": "MANKATO CLINIC, LTD",
"city": "MANKATO",
"state": "MN",
"postal_code": "550028674",
"telephone_number": "507-625-1811",
"fax_number": "218-263-1035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1230 E. MAIN STREET",
"city": "MANKATO",
"state": "MN",
"postal_code": "550028674",
"telephone_number": "507-625-1811",
"fax_number": "218-263-1035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCHUK",
"first_name": "STEPHEN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "37659",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32386400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.