Healthcare Provider Details

I. General information

NPI: 1669581930
Provider Name (Legal Business Name): ELYSE HENRIETTE SCHEUER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MARKET ST SUITE 215
MINNEAPOLIS MN
55405-1627
US

IV. Provider business mailing address

275 MARKET ST STE 215 SUITE 215
MINNEAPOLIS MN
55405-1623
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number47369
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: