MEDICARE: CHILDREN'S RESPIRATORY & CRITICAL CARE SPECIALISTS. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	62826	MN
2	2080P0214X	Pediatric Pulmonology Physician	62826	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003816505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S RESPIRATORY & CRITICAL CARE SPECIALISTS. P.A.

Provider Business Mailing Address
First Line	:	2530 CHICAGO AVE
Second Line	:	SUITE 400
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4387
Country	:	US
Telephone Number	:	612-813-3300
Fax Number	:	612-813-3349

Provider Business Practice Location Address
First Line	:	2530 CHICAGO AVE
Second Line	:	SUITE 400
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4570
Country	:	US
Telephone Number	:	612-813-3300
Fax Number	:	612-813-3349

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MICHAEL FOLEY
Credential	:
Telephone Number	:	612-813-3324

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	09/01/2017

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