Healthcare Provider Details

I. General information

NPI: 1659355741
Provider Name (Legal Business Name): METROPOLITAN OBSTETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W EXCHANGE ST SUITE 622
ST PAUL MN
55102
US

IV. Provider business mailing address

17 W EXCHANGE ST SUITE 622
ST PAUL MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-9141
  • Fax: 651-265-6772
Mailing address:
  • Phone: 651-227-9141
  • Fax: 651-265-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS GRANDE
Title or Position: CEO
Credential: MD
Phone: 651-227-9141