Healthcare Provider Details

I. General information

NPI: 1124100821
Provider Name (Legal Business Name): PAUL NMI DRUCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR #112
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR #112
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-725-2000
  • Fax: 612-725-2227
Mailing address:
  • Phone: 612-725-2000
  • Fax: 612-725-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number33056
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: