Basic Information
| Provider Information | |||||||||
| NPI: | 1467577114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF MINNESOTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT OF NEUROLOGY, UNIVERSITY OF MINNESOTA | ||||||||
| Address2: | 420 DELAWARE STREET SOUTHEAST | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126241903 | ||||||||
| FaxNumber: | 6126257950 | ||||||||
| Practice Location | |||||||||
| Address1: | MINNEAPOLIS VA MEDICAL CENTER | ||||||||
| Address2: | ONE VETERANS DRIVE | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127252230 | ||||||||
| FaxNumber: | 6127252068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROFESSOR | ||||||||
| AuthorizedOfficialTelephone: | 6126241903 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | R 095831-4 | MN | Y | Hospitals | General Acute Care Hospital |
No ID Information.