MEDICARE: DR. DOMINIC ANTHONY PLUCINSKI 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
1	207RC0000X	Cardiovascular Disease Physician	28427	MN
2	207RI0011X	Interventional Cardiology Physician	28427	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902856974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC ANTHONY PLUCINSKI MD

Provider Business Mailing Address
First Line	:	6565 FRANCE AVE S
Second Line	:	STE 101
City	:	EDINA
State	:	MN
Zip	:	55435-2154
Country	:	US
Telephone Number	:	952-500-0653
Fax Number	:	952-892-0254

Provider Business Practice Location Address
First Line	:	6565 FRANCE AVE S
Second Line	:	STE 101
City	:	EDINA
State	:	MN
Zip	:	55435-2154
Country	:	US
Telephone Number	:	763-520-2000
Fax Number	:	763-520-2099

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	04/23/2020

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