Healthcare Provider Details

I. General information

NPI: 1104116722
Provider Name (Legal Business Name): ELISSA MARGUERITE DOWNS MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax: 612-365-8001
Mailing address:
  • Phone: 612-365-6777
  • Fax: 612-365-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number57541
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: