Healthcare Provider Details

I. General information

NPI: 1255588299
Provider Name (Legal Business Name): METROPOLITAN CARDIOLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OSBORNE RD NE SUITE 120
FRIDLEY MN
55432-2765
US

IV. Provider business mailing address

4040 COON RAPIDS BLVD NW SUITE 120
COON RAPIDS MN
55433-4567
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-9980
  • Fax:
Mailing address:
  • Phone: 763-427-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number37940
License Number StateMN

VIII. Authorized Official

Name: DR. MARK A EVANS
Title or Position: PRESIDENT
Credential: MD
Phone: 763-427-9980