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General NPI Number Information
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NPI Number | 1679633093
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Entity Type | Organization
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Legal Business Name | MINNESOTA CLINICAL & NEUROPSYCHOLOGICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 7800 METRO PKWY SUITE 300
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1514
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Country | US
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Telephone | 952-876-0727
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Fax | 952-851-9618
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Provider Business Mailing Address
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Address Line | 7800 METRO PKWY SUITE 300
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1514
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Country | US
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Telephone | 952-876-0727
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Fax | 952-851-9618
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS MICHAEL MISUKANIS
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Credential | PH.D.
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Telephone | 952-876-0727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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