Healthcare Provider Details

I. General information

NPI: 1902168263
Provider Name (Legal Business Name): REBECCA MAHADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HUTCHINS DR SUITE 250
MINNETONKA MN
55345-4145
US

IV. Provider business mailing address

17705 HUTCHINS DR SUITE 250
MINNETONKA MN
55345-4145
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-8300
  • Fax:
Mailing address:
  • Phone: 952-401-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59181
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: