Healthcare Provider Details

I. General information

NPI: 1992769533
Provider Name (Legal Business Name): ENDOCRINOLOGY CLINIC OF MINNEAPOLIS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 YORK AVE S SUITE 180
EDINA MN
55435-5845
US

IV. Provider business mailing address

7701 YORK AVE S SUITE 180
EDINA MN
55435-5845
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-7810
  • Fax: 952-927-6309
Mailing address:
  • Phone: 952-927-7810
  • Fax: 952-927-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1261
License Number StateMN

VIII. Authorized Official

Name: DR. J JEFFREY RUEGEMER
Title or Position: PHYSICIAN
Credential: MD
Phone: 952-927-7810