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General NPI Number Information
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NPI Number | 1942265434
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALTIES, LTD.
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 470 W 78TH ST
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City | CHANHASSEN
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State | MN
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Zip | 55317-4524
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Country | US
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Telephone | 952-224-9350
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Fax | 952-224-9356
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Provider Business Mailing Address
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Address Line | 470 W 78TH ST
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City | CHANHASSEN
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State | MN
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Zip | 55317-4539
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Country | US
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Telephone | 952-224-9350
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Fax | 952-224-9356
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JILL M. JULSRUD
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Credential | M.D.
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Telephone | 952-224-9350
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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 | 186
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License Number State | MN
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