MEDICARE: AERIS MEDICAL GROUP PLLC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1184228520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AERIS MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	5115 EXCELSIOR BLVD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2906
Country	:	US
Telephone Number	:	763-465-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 INGLEWOOD AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4112
Country	:	US
Telephone Number	:	763-465-0500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH GREENBERG
Credential	:
Telephone Number	:	212-734-6621

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	07/24/2025

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