Healthcare Provider Details

I. General information

NPI: 1013004175
Provider Name (Legal Business Name): MIDWEST PLASTIC SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S STE 350
EDINA MN
55435-2120
US

IV. Provider business mailing address

6545 FRANCE AVE S STE 350
EDINA MN
55435-2120
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-2600
  • Fax: 952-920-2668
Mailing address:
  • Phone: 952-920-2600
  • Fax: 952-920-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number1389
License Number StateMN

VIII. Authorized Official

Name: DR. DAVID F RUEBECK
Title or Position: MANAGING PARTNER
Credential: MEDICAL DOCTOR
Phone: 952-920-2600