Healthcare Provider Details

I. General information

NPI: 1972906097
Provider Name (Legal Business Name): MIDWEST MEDICAL CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 BROOKLYN BLVD STE 200
BROOKLYN PARK MN
55429-1280
US

IV. Provider business mailing address

7240 BROOKLYN BLVD STE 200
BROOKLYN PARK MN
55429-1280
US

V. Phone/Fax

Practice location:
  • Phone: 612-875-2733
  • Fax: 763-428-8495
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL ROONEY
Title or Position: PARTNER
Credential:
Phone: 612-875-2733