Healthcare Provider Details

I. General information

NPI: 1619331717
Provider Name (Legal Business Name): CHRISTOPHER PEDERSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 09/09/2023
Certification Date: 09/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 28TH ST STE 300
MINNEAPOLIS MN
55407-1195
US

IV. Provider business mailing address

920 E 28TH ST STE 300
MINNEAPOLIS MN
55407-1195
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number73818
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: