Healthcare Provider Details

I. General information

NPI: 1801485255
Provider Name (Legal Business Name): MICHAEL JAMES GREENSTEIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 08/29/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S STE 150
EDINA MN
55435-2180
US

IV. Provider business mailing address

4064 KOKANEE LN N
LAKE ELMO MN
55042-4001
US

V. Phone/Fax

Practice location:
  • Phone: 952-848-5600
  • Fax:
Mailing address:
  • Phone: 651-238-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: