Healthcare Provider Details

I. General information

NPI: 1639107386
Provider Name (Legal Business Name): CHRISTOPHER DONAHUE PHD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 S 6TH ST STE F256 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55454-1336
US

IV. Provider business mailing address

2312 S 6TH ST STE F256 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55454-1336
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-8700
  • Fax:
Mailing address:
  • Phone: 612-273-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4589
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: