Healthcare Provider Details

I. General information

NPI: 1730113630
Provider Name (Legal Business Name): CENTER FOR REPRODUCTIVE MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 CHICAGO AVE SUITE 400
MINNEAPOLIS MN
55407-1544
US

IV. Provider business mailing address

2828 CHICAGO AVE SUITE 400
MINNEAPOLIS MN
55407-1544
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-5390
  • Fax: 612-863-2697
Mailing address:
  • Phone: 612-863-5390
  • Fax: 612-863-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DARLA J BECKER
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 612-863-5390