Healthcare Provider Details

I. General information

NPI: 1427076033
Provider Name (Legal Business Name): ELEONORE OKOSDINOSSIAN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0222
US

IV. Provider business mailing address

2510 WEXFORD CT
NEW BRIGHTON MN
55112-3147
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42233
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: