Provider Demographics
NPI:1316223159
Name:REGENTS OF THE UNIVERSITY OF MINNESOTA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LISSEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-626-9918
Mailing Address - Street 1:75 E RIVER RD
Mailing Address - Street 2:ELLIOTT HALL, RM# 416
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 E RIVER RD
Practice Address - Street 2:ELLIOTT HALL, RM# 416
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0366
Practice Address - Country:US
Practice Address - Phone:612-626-9918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital