Healthcare Provider Details

I. General information

NPI: 1467524611
Provider Name (Legal Business Name): MICHAEL JEFFREY GARBOW MS LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 W 96TH ST
BLOOMINGTON MN
55431-2606
US

IV. Provider business mailing address

1206 W 96TH ST
BLOOMINGTON MN
55431-2606
US

V. Phone/Fax

Practice location:
  • Phone: 952-884-4882
  • Fax: 952-884-0284
Mailing address:
  • Phone: 952-884-4882
  • Fax: 952-884-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP1233
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: