11Mn

Specialty details in registry · Minneapolis, MN

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At a glance

720 3Rd Ave Ne, Minneapolis, MN 55413-2300

NPPES record updated Aug 17, 2011. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

720 3Rd Ave Ne Ste 109
Minneapolis, MN 55413-2300

Professional details: NPI, taxonomy & registry record

NPI1154601474

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 251S00000X
Enumeration date: Aug 17, 2011
Record updated: Aug 17, 2011

More registry details

Provider type: Organization · Type 2
Other reported name: <UNAVAIL>

Reported taxonomies and licenses

Specialty details in registry

251S00000X · Primary

License reported: 302775 MN

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

720 3Rd Ave Ne
Ste 109
Minneapolis, MN 55413-2300

Phone: (360) 237-2616
Fax: (360) 237-2616

Mailing address

720 3RD AVE NE
STE 109
MINNEAPOLIS, MN 554132300

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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