Provider Demographics
NPI:1518929652
Name:SANDNESS, JOHN GALIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GALIN
Last Name:SANDNESS
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 1:3601 PARK CENTER BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2531
Mailing Address - Country:US
Mailing Address - Phone:952-922-2012
Mailing Address - Fax:
Practice Address - Street 1:3601 PARK CENTER BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2531
Practice Address - Country:US
Practice Address - Phone:952-922-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN282052083P0500X
WI258022083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNB56281Medicare UPIN