Provider Demographics
NPI:1518445691
Name:UNIVERSITY OF MINNESOTA
Entity Type:Organization
Organization Name:UNIVERSITY OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR, NEUROLOGY DEPT.
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VITEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-625-5993
Mailing Address - Street 1:420 DELAWARE ST. SE
Mailing Address - Street 2:MMC295 MAYO
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-4703
Mailing Address - Fax:612-301-1455
Practice Address - Street 1:515 DELAWARE ST. SE
Practice Address - Street 2:MOOS TOWER, ROOM 13-129
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-7403
Practice Address - Fax:612-301-1455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MINNESOTA (NEUROLOGY)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty