Healthcare Provider Details

I. General information

NPI: 1154393122
Provider Name (Legal Business Name): SETH A MYLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11475 ROBINSON DRIVE NW HEALTHPARTNERS COON RAPIDS CLINIC
COON RAPIDS MN
55433-3746
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-9000
  • Fax: 763-587-9130
Mailing address:
  • Phone: 952-883-5375
  • Fax: 763-587-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: