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NPI Code Detail

MEDICARE: PEDIATRIC SURGICAL ASSOCIATES LTD

MEDICARE: PEDIATRIC SURGICAL ASSOCIATES LTD
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
12088P0231XPediatric Urology Physician
22086S0120XPediatric Surgery Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093778292
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC SURGICAL ASSOCIATES LTD
Provider Business Mailing Address
First Line : 4530 W 77TH ST
Second Line : SUITE 205
City : EDINA
State : MN
Zip : 55435-5006
Country : US
Telephone Number : 952-835-9442
Fax Number : 952-835-9443
Provider Business Practice Location Address
First Line : 2530 CHICAGO AVE
Second Line : SUITE 550
City : MINNEAPOLIS
State : MN
Zip : 55404-4289
Country : US
Telephone Number : 612-813-8000
Fax Number : 612-813-8005
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. PAUL LOUISELLE
Credential :
Telephone Number : 612-813-8006
Provider Enumeration Date : 04/10/2006
Last Update Date : 04/08/2026

Similar Medicare Providers

1306847389 — STEVEN E HAUN M.D.
Practice Location Address:
2530 CHICAGO AVE , SUITE 400
MINNEAPOLIS, MN
55404-4289
Practice Phone: 612-813-3300
Practice Fax: 612-813-3349
1205837283 — KRISTINE J HENDRICKSON M.D.
Practice Location Address:
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1811998685 — JULIE HERDA C.P.N.P
Practice Location Address:
2530 CHICAGO AVE , SUITE 400
MINNEAPOLIS, MN
55404-4289
Practice Phone: 612-813-3300
Practice Fax: 612-813-3349
1275534042 — PAUL T KUBIC M.D.
Practice Location Address:
2530 CHICAGO AVE , SUITE 400
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1902807787 — STEPHEN C KURACHEK M.D.
Practice Location Address:
2530 CHICAGO AVE , SUITE 400
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1821099466 — JOHN J MCNAMARA M.D.
Practice Location Address:
2530 CHICAGO AVE , SUITE 400
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55404-4289
Practice Phone: 612-813-3300
Practice Fax: 612-813-3349

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