Healthcare Provider Details

I. General information

NPI: 1013470442
Provider Name (Legal Business Name): MATS STEFFI JENNIFER MASILAMANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MATS STEFFI JENNIFER MASILAMANI MD

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE STE 500
MINNEAPOLIS MN
55404-4291
US

IV. Provider business mailing address

2530 CHICAGO AVE STE 500
MINNEAPOLIS MN
55404-4291
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-8800
  • Fax:
Mailing address:
  • Phone: 612-813-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71134
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: