Healthcare Provider Details

I. General information

NPI: 1649700741
Provider Name (Legal Business Name): ALICE PING GU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 MEMBERS PKWY NW
ROCHESTER MN
55901-8381
US

IV. Provider business mailing address

9400 ZANE AVE N
BROOKLYN PARK MN
55443-1814
US

V. Phone/Fax

Practice location:
  • Phone: 507-218-3701
  • Fax: 507-258-5503
Mailing address:
  • Phone: 763-762-6807
  • Fax: 763-315-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT213134
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number72099
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: