=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174726541
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL TODD HOPFENSPIRGER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 08/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 WATER ST
-----------------------------------------------------
City | EXCELSIOR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55331-3072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-925-5626
-----------------------------------------------------
Fax | 952-925-0223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 WATER ST
-----------------------------------------------------
City | EXCELSIOR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55331-3072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-925-5626
-----------------------------------------------------
Fax | 952-925-0223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 16751
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------