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General NPI Number Information
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NPI Number | 1083031439
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Entity Type | Organization
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Legal Business Name | NEUROLOGY LTD.
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 420 DELAWARE STREET SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-0377
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Country | US
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Telephone | 612-625-1431
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Fax |
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Provider Business Mailing Address
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Address Line | 2259 SUMMIT AVENUE
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City | ST. PAUL
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State | MN
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Zip | 55105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. WILLIAM R KENNEDY
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Credential |
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Telephone | 612-625-1431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 15228
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License Number State | MN
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