Provider Demographics
NPI:1427066067
Name:GETNICK, GEOFFREY SCOTT (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:SCOTT
Last Name:GETNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 FRANCE AVE, SUITE 107
Mailing Address - Street 2:THE EAR NOSE AND THROAT CLINIC & HEARING CENTER
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4738
Mailing Address - Country:US
Mailing Address - Phone:952-832-5252
Mailing Address - Fax:952-548-5254
Practice Address - Street 1:7400 FRANCE AVE S STE 107
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4738
Practice Address - Country:US
Practice Address - Phone:952-832-5252
Practice Address - Fax:952-548-5254
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48364174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN077701300Medicaid