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NPI Code Detail

MEDICARE: MARK A. VIRTUE MD

MEDICARE: MARK A. VIRTUE 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
1207RG0100XGastroenterology Physician47134MN

General Provider Information

NPI Number : 1548315302
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK A. VIRTUE MD
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 : 1185 TOWN CENTRE DR STE 205
Second Line :
City : EAGAN
State : MN
Zip : 55123-1370
Country : US
Telephone Number : 612-871-1145
Fax Number : 612-870-5491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 12/06/2016

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