Provider Demographics
NPI:1275510752
Name:SOPER, MARJORIE K
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:K
Last Name:SOPER
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:PARK NICOLLET CLINIC - HEART & VASCULAR CENTER
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-3246
Practice Address - Fax:952-993-3010
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN40160207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease