Healthcare Provider Details

I. General information

NPI: 1467088849
Provider Name (Legal Business Name): ONCOPLASTIC GENERAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S STE 510
EDINA MN
55435-4551
US

IV. Provider business mailing address

7373 FRANCE AVE S STE 510
EDINA MN
55435-4551
US

V. Phone/Fax

Practice location:
  • Phone: 612-562-8630
  • Fax: 952-830-0091
Mailing address:
  • Phone: 612-562-8630
  • Fax: 952-830-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NORA BURKART
Title or Position: OWNER
Credential: MD
Phone: 612-562-8630