Healthcare Provider Details

I. General information

NPI: 1346241999
Provider Name (Legal Business Name): MICHAEL P PRYOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CHICAGO AVE SUITE 400
MINNEAPOLIS MN
55404-4289
US

IV. Provider business mailing address

2530 CHICAGO AVE SUITE 400
MINNEAPOLIS MN
55404-4289
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-3300
  • Fax: 612-813-3349
Mailing address:
  • Phone: 612-813-3300
  • Fax: 612-813-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35157
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: