1538254289 NPI number — ENDOCRINE & DIABETES ASSOCIATES, P.A.

Table of content: (NPI 1538254289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538254289 NPI number — ENDOCRINE & DIABETES ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOCRINE & DIABETES ASSOCIATES, P.A.
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:
1538254289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 E.24TH ST.
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55404-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-336-5000
Provider Business Mailing Address Fax Number:
612-775-9800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 E 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-336-5000
Provider Business Practice Location Address Fax Number:
612-775-9800
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MULMED
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
612-336-5000

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  20522 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39111EN . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3315697 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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