Healthcare Provider Details

I. General information

NPI: 1902856974
Provider Name (Legal Business Name): DOMINIC ANTHONY PLUCINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FRANCE AVE S STE 101
EDINA MN
55435-2154
US

IV. Provider business mailing address

6565 FRANCE AVE S STE 101
EDINA MN
55435-2154
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-2000
  • Fax: 763-520-2099
Mailing address:
  • Phone: 952-500-0653
  • Fax: 952-892-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28427
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number28427
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: