MEDICARE: MILLENNIUM NEUROSURGERY, PA

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	174400000X	Specialist	1473	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN3928	OTHER	MN	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1851314868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM NEUROSURGERY, PA

Provider Business Mailing Address
First Line	:	1675 BEAM AVE
Second Line	:	SUITE 215
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1172
Country	:	US
Telephone Number	:	651-748-1461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 BEAM AVE
Second Line	:	SUITE 215
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1172
Country	:	US
Telephone Number	:	651-748-1461
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHUDHIPHORN THIENPRASIT
Credential	:	MD
Telephone Number	:	651-748-1461

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	12/05/2007

Similar Medicare Providers

1437151669 — DR. PHUDHIPHORN THIENPRASIT M.D., PH.D
Practice Location Address:

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1134557432 — ST. PAUL OPTICIANS, INC.
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1134061096 — MR. ANDREW JOHN LARSON MS, LPCC, LADC
Practice Location Address:

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1972509248 — MISS DANA MARIE BENASSI D.C.
Practice Location Address:

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1144226200 — DR. GREGORY EUGENE EASTLUND D.C.
Practice Location Address:

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Practice Fax: 651-779-8247

Directions to “MILLENNIUM NEUROSURGERY, PA ” Practice Location

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