Provider Demographics
NPI:1558353698
Name:SMITH, CYNTHIA JANE (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:JANE
Other - Last Name:BANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:7250 FRANCE AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4305
Practice Address - Country:US
Practice Address - Phone:952-926-2300
Practice Address - Fax:952-926-7385
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0406173OtherMEDICA
MN70G91BAOtherBLUE CROSS BLUE SHIELD MN
MNNA3181040233OtherPREFERRED ONE
MNP00059643OtherRAILROAD MEDICARE
MN134500100Medicaid
MN55435A002OtherTRICARE
MN1954423OtherAMERICAS PPO/ARAZ
MNNA3181040233OtherPREFERRED ONE
MN1954423OtherAMERICAS PPO/ARAZ
MN411798069OtherEIN