Basic Information
| Provider Information | |||||||||
| NPI: | 1447229448 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURNSVILLE FAMILY PHYSICIANS, P.A. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 625 E NICOLLET BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553376734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524350303 | ||||||||
| FaxNumber: | 9528925166 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 E NICOLLET BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553376734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524350303 | ||||||||
| FaxNumber: | 9528925166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9524350304 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 968 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.