Provider Demographics
NPI:1386690543
Name:METROPOLITAN NEUROSURGERY, PA
Entity Type:Organization
Organization Name:METROPOLITAN NEUROSURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-427-1137
Mailing Address - Street 1:11850 BLACKFOOT ST NW
Mailing Address - Street 2:STE 490
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2578
Mailing Address - Country:US
Mailing Address - Phone:763-427-1137
Mailing Address - Fax:763-427-4643
Practice Address - Street 1:11850 BLACKFOOT ST NW
Practice Address - Street 2:STE 490
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2578
Practice Address - Country:US
Practice Address - Phone:763-427-1137
Practice Address - Fax:763-427-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN591713100Medicaid