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General NPI Number Information
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NPI Number | 1881815322
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Entity Type | Organization
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Legal Business Name | MARK C ENGASSER M D P A
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 6600 FRANCE AVE S SUITE 615
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City | EDINA
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State | MN
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Zip | 55435-1807
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Country | US
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Telephone | 952-920-4333
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Fax | 952-920-6338
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Provider Business Mailing Address
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Address Line | 6600 FRANCE AVE S SUITE 615
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City | EDINA
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State | MN
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Zip | 55435-1807
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Country | US
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Telephone | 952-920-4333
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Fax | 952-920-6338
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Authorized Official
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Title or Position | OWNER
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Name | MARK CHARLES ENGASSER
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Credential | M.D.
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Telephone | 952-920-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 22841
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License Number State | MN
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