Healthcare Provider Details

I. General information

NPI: 1700863982
Provider Name (Legal Business Name): DARREN R. MCDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 PARK AVENUE S
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

2211 PARK AVENUE S
MINNEAPOLIS MN
55404-3753
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1144
  • Fax: 612-871-2012
Mailing address:
  • Phone: 612-871-1144
  • Fax: 612-871-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number46792
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: