Healthcare Provider Details

I. General information

NPI: 1679633093
Provider Name (Legal Business Name): MINNESOTA CLINICAL & NEUROPSYCHOLOGICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 METRO PKWY SUITE 300
BLOOMINGTON MN
55425-1514
US

IV. Provider business mailing address

7800 METRO PKWY SUITE 300
BLOOMINGTON MN
55425-1514
US

V. Phone/Fax

Practice location:
  • Phone: 952-876-0727
  • Fax: 952-851-9618
Mailing address:
  • Phone: 952-876-0727
  • Fax: 952-851-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS MICHAEL MISUKANIS
Title or Position: OWNER
Credential: PH.D.
Phone: 952-876-0727