Healthcare Provider Details

I. General information

NPI: 1215037080
Provider Name (Legal Business Name): ANNE G MINENKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DELAWARE ST SE PWB SIXTH FLOOR, CLINIC 6A
MINNEAPOLIS MN
55455-0356
US

IV. Provider business mailing address

420 DELAWARE STREET SE, MMC 108 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-8690
  • Fax:
Mailing address:
  • Phone: 612-625-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number42698
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42698
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: