Healthcare Provider Details

I. General information

NPI: 1932333697
Provider Name (Legal Business Name): MARISA A CHAPMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 BARRIE RD
EDINA MN
55435-2305
US

IV. Provider business mailing address

14305 SOUTHCROSS DR W STE 110
BURNSVILLE MN
55306-7011
US

V. Phone/Fax

Practice location:
  • Phone: 952-915-6000
  • Fax: 952-915-6100
Mailing address:
  • Phone: 651-340-1064
  • Fax: 651-330-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number57186
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: