Healthcare Provider Details

I. General information

NPI: 1326242371
Provider Name (Legal Business Name): ERIC M DEAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 140TH ST SUITE 201
BURNSVILLE MN
55337-4480
US

IV. Provider business mailing address

4200 DAHLBERG DR SUITE 300
GOLDEN VALLEY MN
55422-4840
US

V. Phone/Fax

Practice location:
  • Phone: 952-808-3000
  • Fax: 952-808-3001
Mailing address:
  • Phone: 952-512-5600
  • Fax: 952-512-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number56850
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: