Healthcare Provider Details

I. General information

NPI: 1871568261
Provider Name (Legal Business Name): MARK L SOLFELT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W BROADWAY AVE
ROBBINSDALE MN
55422-2969
US

IV. Provider business mailing address

3435 W BROADWAY AVE
ROBBINSDALE MN
55422-2969
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-2800
  • Fax:
Mailing address:
  • Phone: 763-581-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number36931
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: