Basic Information
Provider Information
NPI: 1306136411
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIRANY
FirstName: ANNE-MARIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
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: EDINA
State: MN
PostalCode: 55435
CountryCode: US
TelephoneNumber: 6513121700
FaxNumber: 6513121570
Other Information
ProviderEnumerationDate: 04/10/2011
LastUpdateDate: 08/01/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208C00000X56425MNY Allopathic & Osteopathic PhysiciansColon & Rectal Surgery 

No ID Information.


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