Healthcare Provider Details

I. General information

NPI: 1871974022
Provider Name (Legal Business Name): MARK CIPRIANI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2015
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

1 PARK WEST BLVD STE 330
AKRON OH
44320-4226
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 330-835-5533
  • Fax: 234-312-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.137170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: