Provider Demographics
NPI:1306986518
Name:MINNEAPOLIS VASCULAR PHYSICIANS
Entity type:Organization
Organization Name:MINNEAPOLIS VASCULAR PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:NORBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-398-2203
Mailing Address - Street 1:2800 CAMPUS DRIVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2645
Mailing Address - Country:US
Mailing Address - Phone:763-398-2203
Mailing Address - Fax:763-398-2233
Practice Address - Street 1:2800 CAMPUS DRIVE
Practice Address - Street 2:SUITE 10
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2645
Practice Address - Country:US
Practice Address - Phone:763-398-2203
Practice Address - Fax:763-398-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8587602OtherMINNESOTA TAX ID NUMBER