Healthcare Provider Details

I. General information

NPI: 1437341807
Provider Name (Legal Business Name): ANN MARIE FERGUSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 CENTRAL PARK VILLAGE DR STE 200
EAGAN MN
55121-7707
US

IV. Provider business mailing address

3625 WOODLAND TRL
EAGAN MN
55123-2400
US

V. Phone/Fax

Practice location:
  • Phone: 651-406-8860
  • Fax:
Mailing address:
  • Phone: 708-288-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50228
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: