Provider Demographics
NPI:1477587368
Name:SEVERT, ANTHONY LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LAWRENCE
Last Name:SEVERT
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 PARK AVENUE
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY, HCMC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-873-2036
Mailing Address - Fax:612-904-4567
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:P4
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN415292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN622941700Medicaid
G92375Medicare UPIN
MN622941700Medicaid