Healthcare Provider Details

I. General information

NPI: 1609166768
Provider Name (Legal Business Name): YEVGENIY VLADIMIROVICH SYCHEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E 24TH ST STE 304
MINNEAPOLIS MN
55404-3846
US

IV. Provider business mailing address

3601 W 76TH ST STE 300
EDINA MN
55435-3004
US

V. Phone/Fax

Practice location:
  • Phone: 800-233-8504
  • Fax: 952-460-5274
Mailing address:
  • Phone: 952-929-1131
  • Fax: 952-929-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number63502
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number63502
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: