Provider Demographics
NPI:1477933513
Name:ALMDALE, ANNALISE (MD)
Entity Type:Individual
Prefix:
First Name:ANNALISE
Middle Name:
Last Name:ALMDALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 W 65TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2147
Mailing Address - Country:US
Mailing Address - Phone:952-345-7070
Mailing Address - Fax:952-920-2245
Practice Address - Street 1:3625 W 65TH ST STE 100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2147
Practice Address - Country:US
Practice Address - Phone:952-345-7070
Practice Address - Fax:952-920-2245
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066447207V00000X
MN65150207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology