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NPI Code Detail

MEDICARE: MS. MELISSA CLARE PEITZ PA-C

MEDICARE: MS. MELISSA CLARE PEITZ PA-C
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
1363A00000XPhysician Assistant11936MN

General Provider Information

NPI Number : 1104290634
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELISSA CLARE PEITZ PA-C
Provider Business Mailing Address
First Line : 2550 UNIVERSITY AVE W STE 110N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-2001
Country : US
Telephone Number : 651-602-5311
Fax Number : 651-222-6786
Provider Business Practice Location Address
First Line : 910 E 26TH ST STE 100
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-4552
Country : US
Telephone Number : 612-884-6300
Fax Number : 612-884-6363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2015
Last Update Date : 10/29/2019

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