Healthcare Provider Details

I. General information

NPI: 1336116391
Provider Name (Legal Business Name): MATTHEW P BOENTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S SUITE 210
EDINA MN
55435-2281
US

IV. Provider business mailing address

6545 FRANCE AVE S SUITE 210
EDINA MN
55435-2281
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-2900
  • Fax: 952-928-2944
Mailing address:
  • Phone: 952-928-2900
  • Fax: 952-928-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number43370
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number43370
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: