Provider Demographics
NPI:1255493565
Name:SETTERBERG, STEPHEN ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROGER
Last Name:SETTERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12915 63RD AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6001
Mailing Address - Country:US
Mailing Address - Phone:763-383-5800
Mailing Address - Fax:763-383-5801
Practice Address - Street 1:3010 COLBY ST STE 221
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2056
Practice Address - Country:US
Practice Address - Phone:844-763-3560
Practice Address - Fax:510-680-1849
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2025-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN360512084P0804X, 2084P0800X
CAG-1479582084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND152T45EOtherBCBC
ND18653Medicaid
MN539860600Medicaid
E17757Medicare UPIN
MN539860600Medicaid