Healthcare Provider Details

I. General information

NPI: 1710592837
Provider Name (Legal Business Name): UNIVERSITY OF MINNESOTA PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD STE 255
MINNEAPOLIS MN
55416-1275
US

IV. Provider business mailing address

720 WASHINGTON AVE SE STE 200
MINNEAPOLIS MN
55414-2924
US

V. Phone/Fax

Practice location:
  • Phone: 952-525-4500
  • Fax: 952-525-1560
Mailing address:
  • Phone: 612-884-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SIBERT
Title or Position: CFO
Credential:
Phone: 612-884-0600