Unknown Individual – Family Medicine Physician, NPI 1780644740
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
33rd Avenue South, Wenonah, Minneapolis, Hennepin County, Minnesota, 55417, United States
MS21110Q
MINNEAPOLIS, MN 554254516
Phone: (952) 883-5375
Fax: (651) 254-9426
Type: Mailing
Regions Hospital, 640, Jackson Street, Saint Paul, Ramsey County, Minnesota, 55101, United States
MAIL STOP 11302C, HEALTHPARTNERS REGIONS BEHAVIORAL HEA
ST. PAUL, MN 551012502
Phone: (651) 254-4786
Fax: (651) 254-9426
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55425)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| Clinical Psychologist | MN | |
| - | MN | |
| P S Y C H I A T R Y | MN | |
| Family Practice | MN | |
| - | MN | |
| - | MN | |
| P O D I A T R Y | MN | |
| Physician Assistant | MN | |
| Physician Assistant | MN |
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