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General NPI Number Information
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NPI Number | 1831162601
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Entity Type | Individual
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Provider Name | GEOFFREY J SERVICE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 217 RADIO DR
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City | WOODBURY
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State | MN
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Zip | 55125-5805
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Country | US
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Telephone | 651-702-0750
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Fax | 651-645-6166
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Provider Business Mailing Address
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Address Line | 215 RADIO DR STE 202
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City | WOODBURY
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State | MN
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Zip | 55125-5822
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Country | US
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Telephone | 651-702-0750
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Fax | 651-645-6166
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 73030-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 46856
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License Number State | MN
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