Provider Demographics
NPI:1124482807
Name:FARRELL, MICHAEL SHANE (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:612-262-4258
Practice Address - Street 1:280 SMITH AVE N STE 450
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2481
Practice Address - Country:US
Practice Address - Phone:651-241-5959
Practice Address - Fax:651-241-5958
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2021-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN625152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry