Healthcare Provider Details

I. General information

NPI: 1891723359
Provider Name (Legal Business Name): WILLIAM CHRISTPHER DOWNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CHICAGO AVE PROVIDER ENROLLMENT
MINNEAPOLIS MN
55407-1321
US

IV. Provider business mailing address

1055 WESTGATE DR SUITE 100
SAINT PAUL MN
55114-1065
US

V. Phone/Fax

Practice location:
  • Phone: 612-262-1166
  • Fax: 612-262-4258
Mailing address:
  • Phone: 651-635-9173
  • Fax: 612-262-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number25422
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: