Healthcare Provider Details

I. General information

NPI: 1528070547
Provider Name (Legal Business Name): ATSUKO ISHIKAWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ATSUKO ISHIKAWA MD

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

15 W 44TH ST FL 10
NEW YORK NY
10036-6611
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-6062
  • Fax:
Mailing address:
  • Phone: 212-575-8910
  • Fax: 212-575-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number61679
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: