1518445691 NPI number — UNIVERSITY OF MINNESOTA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518445691 NPI number — UNIVERSITY OF MINNESOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MINNESOTA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518445691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE ST. SE
Provider Second Line Business Mailing Address:
MMC295 MAYO
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-626-4703
Provider Business Mailing Address Fax Number:
612-301-1455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 DELAWARE ST. SE
Provider Second Line Business Practice Location Address:
MOOS TOWER, ROOM 13-129
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-626-7403
Provider Business Practice Location Address Fax Number:
612-301-1455
Provider Enumeration Date:
08/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VITEK
Authorized Official First Name:
JERROLD
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CHAIR, NEUROLOGY DEPT.
Authorized Official Telephone Number:
612-625-5993

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com