Provider Demographics
NPI:1487745253
Name:NOSS, PHYLLIS (MD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:NOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3897
Mailing Address - Country:US
Mailing Address - Phone:218-312-3002
Mailing Address - Fax:218-263-8933
Practice Address - Street 1:1924 DUNEDIN AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-2400
Practice Address - Country:US
Practice Address - Phone:218-724-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN442312085R0202X
MN443212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1602543OtherMEDICA
MN164104OtherUCARE
MNH100320262OtherMEDICARE
MNP00043495OtherRAILROAD MEDICARE
MN087K5NOOtherBLUE CROSS BLUE SHIELD
MN087K5NOOtherBLUE CROSS BLUE SHIELD
MNE79510Medicare UPIN