Healthcare Provider Details

I. General information

NPI: 1013952175
Provider Name (Legal Business Name): CHARLES P REZNIKOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S 8TH ST
MINNEAPOLIS MN
55404-1204
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-5500
  • Fax:
Mailing address:
  • Phone: 763-873-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number48516
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: