Provider Demographics
NPI:1548366867
Name:NORTHWEST FAMILY PHYSICIANS PA
Entity type:Organization
Organization Name:NORTHWEST FAMILY PHYSICIANS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-504-6500
Mailing Address - Street 1:5700 BOTTINEAU BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429
Mailing Address - Country:US
Mailing Address - Phone:763-504-6500
Mailing Address - Fax:763-531-2105
Practice Address - Street 1:5502 W BROADWAY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3508
Practice Address - Country:US
Practice Address - Phone:763-504-6500
Practice Address - Fax:763-504-6544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST FAMILY PHYSICIANS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-15
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN469208000Medicaid
MN469208000Medicaid
MN0817300001Medicare NSC