Healthcare Provider Details

I. General information

NPI: 1396857058
Provider Name (Legal Business Name): MANU MADHOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVENUE SOUTH CHILDRENS HOSPITALS AND CLINICS EMERGENCY PHYSICIANS MP
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

2910 CENTRE POINTE DRIVE 35 121A CHILDRENS HEALTH CARE
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6111
  • Fax:
Mailing address:
  • Phone: 651-855-2109
  • Fax: 651-855-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number41503
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41503
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: