MEDICARE: SIDNEY DAVID ROBERT OXBOROUGH MC

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	390200000X	Student in an Organized Health Care Education/Training Program		MN

General Provider Information

NPI Number	:	1871444778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY DAVID ROBERT OXBOROUGH MC

Provider Business Mailing Address
First Line	:	316 OAK GROVE ST APT 512
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-4053
Country	:	US
Telephone Number	:	612-242-4378
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 W 50TH ST STE 250L
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2047
Country	:	US
Telephone Number	:	612-242-4378
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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