Basic Information
| Provider Information | |||||||||
| NPI: | 1336313386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUMM | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | DEEGAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2829 UNIVERSITY AVE SE STE 730 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554143279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124391867 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 E 28TH ST # MR 11112 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554073723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128634233 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2008 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036126321 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | N8823 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 55961 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.