1720594500 NPI number — PAUL LORENZ BIGLIARDI PROF

Table of content: PAUL LORENZ BIGLIARDI PROF (NPI 1720594500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720594500 NPI number — PAUL LORENZ BIGLIARDI PROF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIGLIARDI
Provider First Name:
PAUL
Provider Middle Name:
LORENZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PROF
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:
1720594500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE STREET SE
Provider Second Line Business Mailing Address:
MMC 98, UNIVERSITY OF MINNESOTA, DEPT OF DERMATOLOGY
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:
612-624-0486
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 FULTON ST SE FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-625-6118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2017

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: 207K00000X , with the licence number:  1007 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 1007 , 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)





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