Healthcare Provider Details

I. General information

NPI: 1861505760
Provider Name (Legal Business Name): MIDWEST INFECTIOUS DISEASE CONSULTANTS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NICOLLET MALL MEDICAL ARTS BUILDING, SUITE # 701
MINNEAPOLIS MN
55402-2606
US

IV. Provider business mailing address

825 NICOLLET MALL MEDICAL ARTS BUILDING, SUITE # 701
MINNEAPOLIS MN
55402-2606
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-1319
  • Fax: 612-333-0894
Mailing address:
  • Phone: 612-333-1319
  • Fax: 612-333-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number22682
License Number StateMN

VIII. Authorized Official

Name: DR. ELLIOT L FRANCKE
Title or Position: OWNER
Credential: M.D.
Phone: 612-333-1319