Healthcare Provider Details

I. General information

NPI: 1649430976
Provider Name (Legal Business Name): MICHAEL F. MCNEELEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD SUITE 190
ST LOUIS PARK MN
55416-2627
US

IV. Provider business mailing address

PO BOX 1450 NW 6035
MINNEAPOLIS MN
55485-6035
US

V. Phone/Fax

Practice location:
  • Phone: 952-541-1840
  • Fax: 952-543-6524
Mailing address:
  • Phone: 952-542-8553
  • Fax: 952-513-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD60235444
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number61319
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: