Provider Demographics
NPI:1235164856
Name:VESSEY, RONALD RICHARD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:RICHARD
Last Name:VESSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL STE 411
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2611
Mailing Address - Country:US
Mailing Address - Phone:612-333-0333
Mailing Address - Fax:612-677-1338
Practice Address - Street 1:825 NICOLLET MALL STE 411
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2611
Practice Address - Country:US
Practice Address - Phone:612-333-0333
Practice Address - Fax:612-677-1338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20835261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA94272Medicare UPIN