Basic Information
| Provider Information | |||||||||
| NPI: | 1104115484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIDURA | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | FRANCES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3433 BROADWAY ST NE STE 115 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554131759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121505 | ||||||||
| FaxNumber: | 6122482944 | ||||||||
| Practice Location | |||||||||
| Address1: | 6565 FRANCE AVE S STE 375 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121700 | ||||||||
| FaxNumber: | 6513121570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2011 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208C00000X | 63765 | MN | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.