Healthcare Provider Details

I. General information

NPI: 1609336452
Provider Name (Legal Business Name): ELOISE GALLIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MARKET ST STE 215
MINNEAPOLIS MN
55405-1623
US

IV. Provider business mailing address

275 MARKET ST STE 215
MINNEAPOLIS MN
55405-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-746-4144
  • Fax: 612-746-4149
Mailing address:
  • Phone: 612-746-4144
  • Fax: 612-746-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number73722
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: