1215370085 NPI number — CHRISTOPHER MICHAEL MCANINCH M.D.

Table of content: CHRISTOPHER MICHAEL MCANINCH M.D. (NPI 1215370085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215370085 NPI number — CHRISTOPHER MICHAEL MCANINCH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCANINCH
Provider First Name:
CHRISTOPHER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1215370085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MINNEAPOLIS VASCULAR PHYSICIANS - MINNEAPOLIS RADIOLOGY
Provider Second Line Business Mailing Address:
2955 XENIUM LANE N SUITE 40
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55441-2668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-398-2203
Provider Business Mailing Address Fax Number:
763-398-6533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 CAMPUS DR STE 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55441-2669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-398-8710
Provider Business Practice Location Address Fax Number:
763-398-8711
Provider Enumeration Date:
04/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  63858 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X , with the licence number: 63252-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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