Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2008-06-26
- Last updated
- 2022-11-07
Specialties
Licenses
- License ND
- TRL10929
- License MN
- 58523
Location
- Practice location
- 9825 HOSPITAL DR STE 300
- City
- MAPLE GROVE MN
- Postal code
- 553694768
- Phone
- 763-587-7900
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.