Healthcare Provider Details

I. General information

NPI: 1952335960
Provider Name (Legal Business Name): J BART MULDOWNEY MN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 FRANCE AVE S SUITE 220
EDINA MN
55435-4787
US

IV. Provider business mailing address

7450 FRANCE AVE S SUITE 220
EDINA MN
55435-4787
US

V. Phone/Fax

Practice location:
  • Phone: 952-925-1111
  • Fax: 952-922-3446
Mailing address:
  • Phone: 952-925-1111
  • Fax: 952-922-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number27468
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: