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General NPI Number Information
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NPI Number | 1932361565
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Entity Type | Organization
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Legal Business Name | MINNESOTA VASCULAR MEDICINE AND BIRTHMARK CENTER
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 14050 NICOLLET AVE SUITE 202
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City | BURNSVILLE
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State | MN
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Zip | 55337-5710
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Country | US
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Telephone | 952-892-3308
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 NICOLLET AVE SUITE 202
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City | BURNSVILLE
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State | MN
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Zip | 55337-5710
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Country | US
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Telephone | 952-892-3308
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHRISTINA DELFANIAN
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Credential |
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Telephone | 952-892-3308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 41861
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License Number State | MN
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