Healthcare Provider Details

I. General information

NPI: 1417912015
Provider Name (Legal Business Name): OLEG FROYMOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 25TH AVE S SUITE 200
MINNEAPOLIS MN
55454-1513
US

IV. Provider business mailing address

701 25TH AVE S SUITE 200
MINNEAPOLIS MN
55454-1513
US

V. Phone/Fax

Practice location:
  • Phone: 612-339-2124
  • Fax: 612-843-3550
Mailing address:
  • Phone: 612-339-2124
  • Fax: 612-843-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number36536
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number34746-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: