MEDICARE: TACJANA KRYSTYNA EICH FRIDAY 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
1	2084N0400X	Neurology Physician	53325	MN
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	53325	MN

General Provider Information

NPI Number	:	1407981210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TACJANA KRYSTYNA EICH FRIDAY MD

Provider Business Mailing Address
First Line	:	3601 MINNESOTA DR STE 200
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55435-5281
Country	:	US
Telephone Number	:	612-879-1000
Fax Number	:	612-879-9116

Provider Business Practice Location Address
First Line	:	11091 ULYSSES ST NE STE 100
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55434-4238
Country	:	US
Telephone Number	:	612-879-1000
Fax Number	:	612-879-9116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/23/2024

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