Healthcare Provider Details

I. General information

NPI: 1316101629
Provider Name (Legal Business Name): CORY PAUL DAIGNAULT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1694 BERKELEY AVE
SAINT PAUL MN
55105-2024
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-2601
  • Fax:
Mailing address:
  • Phone: 612-876-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number52430
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: