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NPI Code Detail

MEDICARE: DR. MICHAEL R. MCNELIS M.D.

MEDICARE: DR. MICHAEL R. MCNELIS M.D.
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
1207V00000XObstetrics & Gynecology Physician45795MN

General Provider Information

NPI Number : 1710063250
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL R. MCNELIS M.D.
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 4300 EDGEWOOD DR NE
Second Line :
City : SAINT MICHAEL
State : MN
Zip : 55376-4588
Country : US
Telephone Number : 763-744-4000
Fax Number : 763-744-4124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 03/29/2021

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