MEDICARE: MARC C SCHIAPPACASSE MA LP

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	103T00000X	Psychologist	0199	MN

General Provider Information

NPI Number	:	1700852852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC C SCHIAPPACASSE MA LP

Provider Business Mailing Address
First Line	:	8100 34TH AVE S
Second Line	:	MC21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1672
Country	:	US
Telephone Number	:	952-883-7172
Fax Number	:	952-883-5395

Provider Business Practice Location Address
First Line	:	5625 CENEX DR
Second Line	:	MAIL STOP 33100A
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55077-1735
Country	:	US
Telephone Number	:	651-552-2600
Fax Number	:	651-552-2614

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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