MEDICARE: SIERRA TROST 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1982345690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA TROST MD

Provider Business Mailing Address
First Line	:	420 DELEWARE ST SE MMC 294
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 DELEWARE ST SE MMC 294
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55445
Country	:	US
Telephone Number	:	612-873-3000
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	06/15/2023

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