MEDICARE: SASHA STRUL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	18348	FL
2	207W00000X	Ophthalmology Physician	MD54237	TN
3	207W00000X	Ophthalmology Physician	62456	MN

General Provider Information

NPI Number	:	1023374964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SASHA STRUL M.D.

Provider Business Mailing Address
First Line	:	701 25TH AVE S STE 300
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 25TH AVE S STE 300
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1443
Country	:	US
Telephone Number	:	612-365-6777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	08/01/2017

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