Healthcare Provider Details

I. General information

NPI: 1487632501
Provider Name (Legal Business Name): ST PAUL CARDIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 EXCHANGE ST W SUITE 750
SAINT PAUL MN
55102-1045
US

IV. Provider business mailing address

17 EXCHANGE ST W SUITE 750
SAINT PAUL MN
55102-1045
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-4340
  • Fax: 651-232-4198
Mailing address:
  • Phone: 651-232-4340
  • Fax: 651-232-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMN

VIII. Authorized Official

Name: LESLIE B FORGOSH
Title or Position: PRESIDENT
Credential: MD
Phone: 651-232-4340