1770564932 NPI number — BRIAN ERIC UNGLAUB ANP GNP

Table of content: BRIAN ERIC UNGLAUB ANP GNP (NPI 1770564932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770564932 NPI number — BRIAN ERIC UNGLAUB ANP GNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNGLAUB
Provider First Name:
BRIAN
Provider Middle Name:
ERIC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP GNP
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:
1770564932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 UNIVERSITY AVE W STE 110N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55114-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-602-5335
Provider Business Mailing Address Fax Number:
651-665-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6545 FRANCE AVE S STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-928-2900
Provider Business Practice Location Address Fax Number:
952-928-2944
Provider Enumeration Date:
11/07/2005

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: 363LA2200X , with the licence number:  R 143562 9 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: R143562-9 , 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: P00181148 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132656 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 328604500 . This is a "MEDICAL ASSISTANCE MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 387L4UN . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0407066 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2258979 . This is a "ARAZ GROUP AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 495R2UN PL . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1042810 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP49290 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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