Healthcare Provider Details

I. General information

NPI: 1710920277
Provider Name (Legal Business Name): MARK BEVERS SIGMOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 FRANCE AVE S SUITE 605
EDINA MN
55435-1805
US

IV. Provider business mailing address

6600 FRANCE AVE S SUITE 605
EDINA MN
55435-1805
US

V. Phone/Fax

Practice location:
  • Phone: 952-915-8322
  • Fax: 952-920-2561
Mailing address:
  • Phone: 952-915-8322
  • Fax: 952-920-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number21645
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: