Provider Demographics
NPI:1417911884
Name:ENGASSER, MARK CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:ENGASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6600 FRANCE AVE S
Mailing Address - Street 2:SUITE 615
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1807
Mailing Address - Country:US
Mailing Address - Phone:952-920-4333
Mailing Address - Fax:952-920-2561
Practice Address - Street 1:6600 FRANCE AVE S
Practice Address - Street 2:SUITE 615
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1807
Practice Address - Country:US
Practice Address - Phone:952-920-4333
Practice Address - Fax:952-920-6338
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN22841207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN856500700Medicaid
MN856500700Medicaid
MNC03813Medicare ID - Type Unspecified
MN0549990005Medicare NSC
MN0549990004Medicare NSC