Provider Demographics
NPI:1417912015
Name:FROYMOVICH, OLEG (MD)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:FROYMOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 25TH AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1513
Mailing Address - Country:US
Mailing Address - Phone:612-339-2124
Mailing Address - Fax:612-843-3550
Practice Address - Street 1:701 25TH AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1513
Practice Address - Country:US
Practice Address - Phone:612-339-2124
Practice Address - Fax:612-843-3550
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36536207Y00000X
WI34746-020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34746-020OtherWISC LICENSE NUMBER
MN961121000169OtherPREFERRED ONE
MN1028424OtherSELECT CARE
MN112123C986OtherUCARE
MN20942OtherAMERICAS PPO
MN2M287FROtherBCBS OF MN
WI32002100Medicaid
MN724365100Medicaid
FMF58068OtherWAUSAU/PT CHOICE
MNHP13326OtherHEALTH PARTNERS
MN1028424OtherMEDICA
MN961121000169OtherPREFERRED ONE
MN20942OtherAMERICAS PPO
MNHP13326OtherHEALTH PARTNERS
MN1028424OtherSELECT CARE
MN724365100Medicaid