1417912015 NPI number — OLEG FROYMOVICH M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417912015 NPI number — OLEG FROYMOVICH M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FROYMOVICH

Provider First Name:

OLEG

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1417912015

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/27/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

701 25TH AVE S

Provider Second Line Business Mailing Address:

SUITE 200

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55454-1513

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-339-2124

Provider Business Mailing Address Fax Number:

612-843-3550

Provider First Line Business Practice Location Address:

701 25TH AVE S

Provider Second Line Business Practice Location Address:

SUITE 200

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55454-1513

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-339-2124

Provider Business Practice Location Address Fax Number:

612-843-3550

Provider Enumeration Date:

04/18/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Y00000X , with the licence number:  36536 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207Y00000X , with the licence number: 34746-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 34746-020 . This is a "WISC LICENSE NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
• Identifier: 961121000169 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1028424 . This is a "SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 112123C986 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 20942 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2M287FR . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 32002100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 724365100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: F58068 . This is a "WAUSAU/PT CHOICE" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
• Identifier: HP13326 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1028424 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".