MEDICARE: DR. PHILIP J FALLT 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	207V00000X	Obstetrics & Gynecology Physician	31855	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	:	1659395903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP J FALLT MD

Provider Business Mailing Address
First Line	:	1020 W BROADWAY
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2504
Country	:	US
Telephone Number	:	612-302-8200
Fax Number	:	612-302-8275

Provider Business Practice Location Address
First Line	:	1020 W BROADWAY
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2504
Country	:	US
Telephone Number	:	612-302-8200
Fax Number	:	612-302-8275

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/16/2010

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