Healthcare Provider Details

I. General information

NPI: 1659563765
Provider Name (Legal Business Name): ELENA BOND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 98TH ST
BLOOMINGTON MN
55420
US

IV. Provider business mailing address

10000 ZANE AVE N COLUMBIA PARK MEDICAL GROUP
BROOKLYN PARK MN
55443-1400
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-6060
  • Fax:
Mailing address:
  • Phone: 763-572-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50382
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: