Provider Demographics
NPI:1467088849
Name:ONCOPLASTIC GENERAL SURGERY LLC
Entity Type:Organization
Organization Name:ONCOPLASTIC GENERAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-562-8630
Mailing Address - Street 1:7373 FRANCE AVE S STE 510
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4551
Mailing Address - Country:US
Mailing Address - Phone:612-562-8630
Mailing Address - Fax:952-830-0091
Practice Address - Street 1:7373 FRANCE AVE S STE 510
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4551
Practice Address - Country:US
Practice Address - Phone:612-562-8630
Practice Address - Fax:952-830-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty