Healthcare Provider Details

I. General information

NPI: 1942228168
Provider Name (Legal Business Name): MARK R MIGLIORI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/16/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 FRANCE AVE S STE 220
EDINA MN
55435-4792
US

IV. Provider business mailing address

7450 FRANCE AVE S STE 220
EDINA MN
55435-4792
US

V. Phone/Fax

Practice location:
  • Phone: 952-925-1111
  • Fax: 952-942-3446
Mailing address:
  • Phone: 952-925-1111
  • Fax: 952-922-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number35467
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number35467
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: