Active NPI
Michael Stockman, DO
- Geriatric Medicine (Internal Medicine) Physician
- St Louis Park, MN
National Provider Identifier
1790762482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 44102
- Practice address
- 3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527 - Phone
- (952) 993-5041
- NPI assigned
- Dec 23, 2005
- 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 |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 44102 | MN | Primary |
Addresses
Primary practice location
3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Mailing address
3850 Park Nicollet Blvd
Minneapolis, MN 55416-2527
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44102 | MN | MD | Geriatric Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341446400000",
"number": "1790762482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3850 PARK NICOLLET BLVD",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554162527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3850 PARK NICOLLET BLVD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554162527",
"telephone_number": "952-993-5041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOCKMAN",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-23",
"last_updated": "2012-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "MN",
"license": "44102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.