Healthcare Provider Details

I. General information

NPI: 1871594341
Provider Name (Legal Business Name): MINNEAPOLIS RADIOLOGY ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

2955 XENIUM LN N SUITE 40
PLYMOUTH MN
55441-2666
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-2171
  • Fax: 763-694-9000
Mailing address:
  • Phone: 763-398-2203
  • Fax: 763-398-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number173
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number173
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number173
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number173
License Number StateMN
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA G NORBY
Title or Position: EXECUTIVE ASSISTANT/CREDENTIALING
Credential:
Phone: 763-398-2203