Healthcare Provider Details

I. General information

NPI: 1205828308
Provider Name (Legal Business Name): PETER H HELSETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N CHILDRENS HOSPITALS AND CLINICS-PATHOLOGY-STPL
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

2910 CENTRE POINTE DR 35-121A, CHILDRENS HEALTH CARE
ROSEVILLE MN
55113-1182
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6563
  • Fax: 651-220-5280
Mailing address:
  • Phone: 651-855-2327
  • Fax: 651-855-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number34838
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: