Basic Information
| Provider Information | |||||||||
| NPI: | 1235197526 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINNESOTA ORTHOPAEDIC SPECIALISTS, P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 701 25TH AVE S | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124552008 | ||||||||
| FaxNumber: | 6124552045 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 25TH AVE S | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124552008 | ||||||||
| FaxNumber: | 6124552045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCMAHON | ||||||||
| AuthorizedOfficialFirstName: | JACKIE | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6124552013 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.