Healthcare Provider Details

I. General information

NPI: 1750607693
Provider Name (Legal Business Name): DARLENE MICHELE SPARKMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARLENE MICHELE GUSE MD

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3110
  • Fax:
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberQ7482
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberQ7482
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101274348
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number76282
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: