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General NPI Number Information
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NPI Number | 1952307175
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Entity Type | Organization
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Legal Business Name | MIDWEST RADIOLOGY, PA
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 2355 HWY 36 W. STE. 100
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City | ROSEVILLE
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State | MN
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Zip | 55113-3905
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Country | US
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Telephone | 651-292-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 HIGHWAY 36 W STE 100
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City | ROSEVILLE
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State | MN
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Zip | 55113-3905
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Country | US
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Telephone | 651-292-2000
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SEE YANG
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Credential |
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Telephone | 651-292-2013
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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 | 43
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License Number State | MN
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