Healthcare Provider Details

I. General information

NPI: 1316223159
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MINNESOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E RIVER RD ELLIOTT HALL, RM# 416
MINNEAPOLIS MN
55455-0366
US

IV. Provider business mailing address

75 E RIVER RD ELLIOTT HALL, RM# 416
MINNEAPOLIS MN
55455-0366
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-9918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. SHMUEL LISSEK
Title or Position: ASSISTANT PROFESSOR
Credential: PHD
Phone: 612-626-9918