Healthcare Provider Details

I. General information

NPI: 1235197526
Provider Name (Legal Business Name): MINNESOTA ORTHOPAEDIC SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 25TH AVE S SUITE 505
MINNEAPOLIS MN
55454-1513
US

IV. Provider business mailing address

701 25TH AVE S SUITE 505
MINNEAPOLIS MN
55454-1513
US

V. Phone/Fax

Practice location:
  • Phone: 612-455-2008
  • Fax: 612-455-2045
Mailing address:
  • Phone: 612-455-2008
  • Fax: 612-455-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. JACKIE I MCMAHON
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-455-2013