Healthcare Provider Details

I. General information

NPI: 1386690543
Provider Name (Legal Business Name): METROPOLITAN NEUROSURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/12/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 BLACKFOOT ST NW STE 490
COON RAPIDS MN
55433-2578
US

IV. Provider business mailing address

11850 BLACKFOOT ST NW STE 490
COON RAPIDS MN
55433-2578
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-1137
  • Fax: 763-427-4643
Mailing address:
  • Phone: 763-427-1137
  • Fax: 763-427-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KYLE S NELSON
Title or Position: PRESIDENT
Credential:
Phone: 763-427-1137