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General NPI Number Information
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NPI Number | 1760435242
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Entity Type | Organization
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Legal Business Name | WESTERN ORTHOPAEDIC SURGERY, LTD.
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6490 EXCELSIOR BLVD W-417
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-4705
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Country | US
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Telephone | 763-694-2977
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 GAMBLE DR SUITE 540
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1521
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Country | US
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Telephone | 763-694-2977
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NOLAN M. SEGAL
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Credential | M.D.
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Telephone | 763-694-2977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22951
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License Number State | MN
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