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General NPI Number Information
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NPI Number | 1881690097
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Entity Type | Organization
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Legal Business Name | MINNESOTA NEONATAL PHYSICIANS PA
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 9875 HOSPITAL DR
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4648
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Country | US
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Telephone | 612-322-6903
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Fax |
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Provider Business Mailing Address
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Address Line | 9325 UPLAND LN N STE 360
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4463
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Country | US
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Telephone | 612-322-6903
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Fax | 763-416-0158
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KELLI BROWN
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Credential |
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Telephone | 612-322-6905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 1251
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License Number State | MN
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