Basic Information
| Provider Information | |||||||||
| NPI: | 1295707792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HELMY | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | MARIE LIZA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GERCHEVA | ||||||||
| OtherFirstName: | SONIA | ||||||||
| OtherMiddleName: | MARIE LIZA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8450 SEASONS PKWY | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517025300 | ||||||||
| FaxNumber: | 6517025305 | ||||||||
| Practice Location | |||||||||
| Address1: | 8450 SEASONS PKWY | ||||||||
| Address2: | MAIL STOP 32300A | ||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517025300 | ||||||||
| FaxNumber: | 6517025305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 08/19/2008 | ||||||||
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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 | 208000000X | 45999 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 929634400 | 05 | MN | MEDICAID |