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NPI Code Detail

MEDICARE: BRIAN J DE MICHAELIS MD

MEDICARE: BRIAN J DE MICHAELIS 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
12085R0202XDiagnostic Radiology Physician42494MN
22085B0100XBody Imaging Physician42494MN
32085U0001XDiagnostic Ultrasound Physician42494MN
42085N0700XNeuroradiology Physician42494MN
52085N0904XNuclear Radiology Physician42494MN

Other Identifiers

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

General Provider Information

NPI Number : 1891795928
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN J DE MICHAELIS MD
Provider Business Mailing Address
First Line : 2800 CAMPUS DR
Second Line : #10
City : PLYMOUTH
State : MN
Zip : 55441-2645
Country : US
Telephone Number : 763-559-2171
Fax Number : 763-694-9000
Provider Business Practice Location Address
First Line : 3300 OAKDALE AVE N
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2926
Country : US
Telephone Number : 763-559-2171
Fax Number : 763-694-9000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 03/03/2009

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