Healthcare Provider Details

I. General information

NPI: 1134508054
Provider Name (Legal Business Name): MEHMET GENCTURK M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 HWY 36 W. STE. 100
ROSEVILLE MN
55113
US

IV. Provider business mailing address

2355 HWY 36 W. STE. 100
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-7422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number64981
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number64981
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: