Healthcare Provider Details

I. General information

NPI: 1548214521
Provider Name (Legal Business Name): PETER ANAGNOSTOPOULOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER C. ANAGNOS MD

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 MARKETPOINTE DR STE 100
BLOOMINGTON MN
55435
US

IV. Provider business mailing address

4300 MARKETPOINTE DR STE 100
BLOOMINGTON MN
55435-5435
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-9880
  • Fax: 952-857-1554
Mailing address:
  • Phone: 952-835-9880
  • Fax: 952-857-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number40628
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40628
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: