Healthcare Provider Details

I. General information

NPI: 1942269154
Provider Name (Legal Business Name): FRANZ-JOSEF EDWARD REISDORF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SMITH AVE N SUITE 500
SAINT PAUL MN
55102-2534
US

IV. Provider business mailing address

225 SMITH AVE N SUITE 500
SAINT PAUL MN
55102-2534
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-0616
  • Fax: 651-726-7256
Mailing address:
  • Phone: 651-292-0616
  • Fax: 651-726-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number38057
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: