Provider Demographics
NPI:1487632501
Name:ST PAUL CARDIOLOGY PA
Entity Type:Organization
Organization Name:ST PAUL CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FORGOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-232-4340
Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:SUITE 750
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-232-4340
Mailing Address - Fax:651-232-4198
Practice Address - Street 1:17 EXCHANGE ST W
Practice Address - Street 2:SUITE 750
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1045
Practice Address - Country:US
Practice Address - Phone:651-232-4340
Practice Address - Fax:651-232-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty