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General NPI Number Information
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NPI Number | 1083894836
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Entity Type | Organization
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Legal Business Name | VASCULAR SURGERY ASSOCIATES PA
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 11855 ULYSSES ST NE STE 220
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City | BLAINE
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State | MN
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Zip | 55434-4181
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Country | US
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Telephone | 763-427-8547
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Fax | 763-576-5394
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Provider Business Mailing Address
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Address Line | 11855 ULYSSES ST NE STE 220
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City | BLAINE
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State | MN
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Zip | 55434-4181
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Country | US
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Telephone | 763-427-8547
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Fax | 763-576-5394
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. CRAIG STUART WALVATNE
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Credential | MD
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Telephone | 763-427-8547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 31967
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License Number State | MN
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