Healthcare Provider Details

I. General information

NPI: 1396976437
Provider Name (Legal Business Name): GREAT PLANES REPRODUCTIVE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 ELM CREEK BLVD N SUITE 350
MAPLE GROVE MN
55369-7073
US

IV. Provider business mailing address

12000 ELM CREEK BLVD N SUITE 350
MAPLE GROVE MN
55369-7073
US

V. Phone/Fax

Practice location:
  • Phone: 763-494-7700
  • Fax: 763-494-7706
Mailing address:
  • Phone: 763-494-7700
  • Fax: 763-494-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDLE S CORFMAN
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: PH.D, M.D.
Phone: 763-494-7700