Healthcare Provider Details

I. General information

NPI: 1124346119
Provider Name (Legal Business Name): PEI MI M.D, PH.D, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WABASHA ST S MAIL STOP: 31300A
SAINT PAUL MN
55107-1805
US

IV. Provider business mailing address

205 WABASHA ST S MAIL STOP: 31300A
SAINT PAUL MN
55107-1805
US

V. Phone/Fax

Practice location:
  • Phone: 651-293-8269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number54788
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: