Healthcare Provider Details

I. General information

NPI: 1083641922
Provider Name (Legal Business Name): RICHARD M SALIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 37TH AVE N STE 150
PLYMOUTH MN
55446-3675
US

IV. Provider business mailing address

710 COMMERCE DR STE 200
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5201
  • Fax: 651-968-5904
Mailing address:
  • Phone: 651-968-5201
  • Fax: 651-968-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number23220
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: