Provider Demographics
NPI:1588802201
Name:IDELKOPE, BRIAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:IDELKOPE
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 1:3400 W 66TH ST STE 385
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2197
Mailing Address - Country:US
Mailing Address - Phone:952-920-2761
Mailing Address - Fax:952-920-0383
Practice Address - Street 1:3400 W 66TH ST STE 385
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2197
Practice Address - Country:US
Practice Address - Phone:952-920-2761
Practice Address - Fax:952-920-0383
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine