Healthcare Provider Details

I. General information

NPI: 1720033640
Provider Name (Legal Business Name): JOSEPH MICHAEL GONZALEZ-CAMPOY M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 TOWN CENTRE DR SUITE 220
EAGAN MN
55123-1187
US

IV. Provider business mailing address

1185 TOWN CENTRE DR SUITE 220
EAGAN MN
55123-1187
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-1600
  • Fax: 651-379-1650
Mailing address:
  • Phone: 651-379-1600
  • Fax: 651-379-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35393
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: