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General NPI Number Information
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NPI Number | 1427158427
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Entity Type | Individual
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Provider Name | PARESH SUBASHCHANDRA GHODGE MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 8100 W 78TH ST STE 230
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City | EDINA
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State | MN
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Zip | 55439-2570
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Country | US
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Telephone | 952-946-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 52448
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 52448
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License Number State | MN
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