Provider Demographics
NPI:1437593993
Name:MEDINA, EDUARDO MIGUEL (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:MIGUEL
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BLAISDELL AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2414
Mailing Address - Country:US
Mailing Address - Phone:952-993-8142
Mailing Address - Fax:952-993-8039
Practice Address - Street 1:2001 BLAISDELL AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2414
Practice Address - Country:US
Practice Address - Phone:952-993-8142
Practice Address - Fax:952-993-8039
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty