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General NPI Number Information
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NPI Number | 1851314868
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Entity Type | Organization
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Legal Business Name | MILLENNIUM NEUROSURGERY, PA
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 1675 BEAM AVE SUITE 215
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1172
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Country | US
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Telephone | 651-748-1461
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 BEAM AVE SUITE 215
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1172
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Country | US
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Telephone | 651-748-1461
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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. PHUDHIPHORN THIENPRASIT
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Credential | MD
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Telephone | 651-748-1461
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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 | 1473
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License Number State | MN
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