Healthcare Provider Details

I. General information

NPI: 1336677483
Provider Name (Legal Business Name): MEDSTUDIO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CHESHIRE LN STE 100
MINNETONKA MN
55305-1053
US

IV. Provider business mailing address

PO BOX 308
FOREST LAKE MN
55025-0308
US

V. Phone/Fax

Practice location:
  • Phone: 952-807-0415
  • Fax:
Mailing address:
  • Phone: 952-807-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT SIEMAN
Title or Position: OWNER
Credential: DO
Phone: 952-807-0415