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General NPI Number Information
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NPI Number | 1922009471
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Entity Type | Organization
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Legal Business Name | MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 9855 HOSPITAL DRIVE #105
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4776
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Country | US
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Telephone | 763-559-2171
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Fax | 763-398-4401
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Provider Business Mailing Address
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Address Line | 9855 HOSPITAL DRIVE #150
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4776
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Country | US
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Telephone | 763-559-2171
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Fax | 763-398-6364
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Authorized Official
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Title or Position | CREDENTIALING
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Name | KRISTEN CARLSON
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Credential |
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Telephone | 763-398-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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