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NPI Code Detail

MEDICARE: DAVID L COUNCILMAN MD

MEDICARE: DAVID L COUNCILMAN MD
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
1207Q00000XFamily Medicine Physician38144MN

General Provider Information

NPI Number : 1174578850
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID L COUNCILMAN MD
Provider Business Mailing Address
First Line : 701 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55415-1623
Country : US
Telephone Number : 612-873-3000
Fax Number :
Provider Business Practice Location Address
First Line : 2810 NICOLLET AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-4708
Country : US
Telephone Number : 612-873-6963
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 07/17/2020

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Directions to “ DAVID L COUNCILMAN MD” Practice Location

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