MEDICARE: DR. ALISON MARIE BORMANN M.D

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	207RI0200X	Infectious Disease Physician	51567	MN

General Provider Information

NPI Number	:	1669659330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISON MARIE BORMANN M.D

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W LAKE ST STE 201
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3565
Country	:	US
Telephone Number	:	612-824-1772
Fax Number	:

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

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	11/10/2020

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