Healthcare Provider Details

I. General information

NPI: 1871734889
Provider Name (Legal Business Name): NAOMI R MRAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

2501 INGLEWOOD AVE S
ST LOUIS PARK MN
55416-3947
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-5460
  • Fax:
Mailing address:
  • Phone: 612-201-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number53415
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: