Healthcare Provider Details

I. General information

NPI: 1538326327
Provider Name (Legal Business Name): MOUSTAPHA ATOUI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 COON RAPIDS BLVD NW STE 120
COON RAPIDS MN
55433-4568
US

IV. Provider business mailing address

1200 SIXTH AVE N
ST CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-9980
  • Fax: 763-427-0904
Mailing address:
  • Phone: 320-656-7020
  • Fax: 320-255-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301513569
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301513569
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number60387
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: