MEDICARE: ELLEN M COFFEY MD

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	207R00000X	Internal Medicine Physician	35820	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	:	1407803943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN M COFFEY MD

Provider Business Mailing Address
First Line	:	701 PARK AVE # P7
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1623
Country	:	US
Telephone Number	:	763-873-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 PARK AVE (P7)
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1829
Country	:	US
Telephone Number	:	612-873-2300
Fax Number	:	612-904-4261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	10/15/2012

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Directions to “ ELLEN M COFFEY MD” Practice Location

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