Healthcare Provider Details

I. General information

NPI: 1669487021
Provider Name (Legal Business Name): HOLLIS ELAINE KRUG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1 VETERANS DR RHEUMATOLOGY (111R)
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR RHEUMATOLOGY (111R)
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4190
  • Fax: 612-725-2267
Mailing address:
  • Phone: 612-467-4190
  • Fax: 612-725-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number29140
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: