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General NPI Number Information
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NPI Number | 1164477709
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Entity Type | Organization
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Legal Business Name | MINNESOTA CENTER FOR OBESITY, METABOLISM & ENDOCRINOLOGY, PA
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 1185 TOWN CENTRE DR SUITE 220
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City | EAGAN
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State | MN
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Zip | 55123-1187
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Country | US
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Telephone | 651-379-1600
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Fax | 651-379-1650
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Provider Business Mailing Address
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Address Line | 1185 TOWN CENTRE DR SUITE 220
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City | EAGAN
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State | MN
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Zip | 55123-1187
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Country | US
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Telephone | 651-379-1600
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Fax | 651-379-1650
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Authorized Official
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Title or Position | COO
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Name | REBECCA GONZALEZ-CAMPOY
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Credential |
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Telephone | 651-379-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1591
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 1591
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License Number State | MN
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