Healthcare Provider Details

I. General information

NPI: 1326257452
Provider Name (Legal Business Name): NORTHWEST SUBURBAN UROLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 OHMS LN
EDINA MN
55439-2148
US

IV. Provider business mailing address

7261 OHMS LN
EDINA MN
55439-2148
US

V. Phone/Fax

Practice location:
  • Phone: 952-843-4300
  • Fax: 952-843-4301
Mailing address:
  • Phone: 952-843-4300
  • Fax: 952-843-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38356
License Number StateMN

VIII. Authorized Official

Name: MICHAEL LONG TRAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 952-843-4300