Medical school: UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Graduated: 2013
Offers telehealth
NPI: 1194169946
Practice Locations (5)
PO BOX, 1309 MAIL STOP 21110Q
MINNEAPOLIS, MN 554401309
450 EASTVOLD AVE
ORTONVILLE, MN 562781252
PARK NICOLLET HEALTH SERVICES CREDENTIALING, 3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
15 GRUMMAN RD W, SUITE 1400
BETHPAGE, NY 117145029
PO BOX, SUITE 5074
SIOUX FALLS, SD 571175074
Source: CMS National Downloadable File, September 2026.