MEDICARE: MELISSA FERRAZ DE TOLEDO

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	363AM0700X	Medical Physician Assistant	1987	MN

General Provider Information

NPI Number	:	1477981777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA FERRAZ DE TOLEDO

Provider Business Mailing Address
First Line	:	PO BOX 14909
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-0909
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5491

Provider Business Practice Location Address
First Line	:	9145 SPRINGBROOK DR NW STE 300
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-5897
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5491

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

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	10/23/2013

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