MEDICARE: RONALD TOLEDO CARDOSO

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	363A00000X	Physician Assistant	14688	MN

General Provider Information

NPI Number	:	1902574197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD TOLEDO CARDOSO

Provider Business Mailing Address
First Line	:	365 NICOLLET MALL STE 1007
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-4427
Country	:	US
Telephone Number	:	630-523-2661
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 NICOLLET MALL STE 1007
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-4427
Country	:	US
Telephone Number	:	630-523-2661
Fax Number	:

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	03/29/2024

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