Healthcare Provider Details

I. General information

NPI: 1336672930
Provider Name (Legal Business Name): NAOKO ONIZUKA M.D., PH.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAOKO NISHIYAMA M.D., PH.D., M.P.H.

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 LOUISIANA AVE S
ST LOUIS PARK MN
55426-5000
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 284
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3230
  • Fax: 952-993-1748
Mailing address:
  • Phone: 612-626-5454
  • Fax: 612-625-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number67089
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number67089
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number67089
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: