Healthcare Provider Details

I. General information

NPI: 1306958376
Provider Name (Legal Business Name): ROMAN JOSEPH ZOWNIROWYCZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CENTRAL AVE NE
MINNEAPOLIS MN
55421-2968
US

IV. Provider business mailing address

6401 UNIVERSITY AVE NE
FRIDLEY MN
55432-4341
US

V. Phone/Fax

Practice location:
  • Phone: 763-572-5710
  • Fax: 763-782-8100
Mailing address:
  • Phone: 763-572-5710
  • Fax: 763-571-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28461
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: