Healthcare Provider Details

I. General information

NPI: 1801865506
Provider Name (Legal Business Name): MARK D SBOROV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S SUITE #210
EDINA MN
55435-2131
US

IV. Provider business mailing address

MINNESOTA ONCOLOGY 2550 UNIVERSITY AVE W
SAINT PAUL MN
55114-2001
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-2900
  • Fax: 952-928-2944
Mailing address:
  • Phone: 651-602-5311
  • Fax: 651-222-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number23282
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: