Healthcare Provider Details

I. General information

NPI: 1275153470
Provider Name (Legal Business Name): MOLLY CATHERINE FAVOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAKE DR E
CHANHASSEN MN
55317-9302
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4300
  • Fax: 952-993-4320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number69875
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: