Healthcare Provider Details

I. General information

NPI: 1528354065
Provider Name (Legal Business Name): SUZANNE MARIE ESPENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W 78TH ST SUITE 100
EDINA MN
55439-2516
US

IV. Provider business mailing address

8100 W 78TH ST SUITE 100
EDINA MN
55439-2516
US

V. Phone/Fax

Practice location:
  • Phone: 952-914-8100
  • Fax: 952-914-8101
Mailing address:
  • Phone: 952-914-8100
  • Fax: 952-914-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55272
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: