Healthcare Provider Details

I. General information

NPI: 1619111705
Provider Name (Legal Business Name): MINNESOTA ONCOLOGY HEMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 BLACKFOOT NW SUITE 100
COON RAPIDS MN
55433-2569
US

IV. Provider business mailing address

11850 BLACKFOOT NW SUITE 100
COON RAPIDS MN
55433-2569
US

V. Phone/Fax

Practice location:
  • Phone: 763-712-2100
  • Fax: 763-712-2190
Mailing address:
  • Phone: 763-712-2100
  • Fax: 763-712-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1076
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1076
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1076
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1076
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1076
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1076
License Number StateMN
# 7
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number1076
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number1076
License Number StateMN
# 9
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number1076
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number1076
License Number StateMN
# 11
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number1076
License Number StateMN

VIII. Authorized Official

Name: DR. DEAN GESME
Title or Position: PRESIDENT
Credential: MD
Phone: 612-884-6300