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NPI Code Detail

MEDICARE: EMILY FRANCES MIDURA M.D.

MEDICARE: EMILY FRANCES MIDURA 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
1390200000XStudent in an Organized Health Care Education/Training Program
2208C00000XColon & Rectal Surgery Physician63765MN

General Provider Information

NPI Number : 1104115484
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY FRANCES MIDURA M.D.
Provider Business Mailing Address
First Line : 3433 BROADWAY ST NE STE 115
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1759
Country : US
Telephone Number : 651-312-1505
Fax Number : 612-248-2944
Provider Business Practice Location Address
First Line : 6363 FRANCE AVE S STE 400
Second Line :
City : EDINA
State : MN
Zip : 55435-2142
Country : US
Telephone Number : 651-312-1700
Fax Number : 651-312-1570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2011
Last Update Date : 08/04/2025

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