Provider Demographics
NPI:1609162387
Name:VIAU COLINDRES, JOHANNA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIA
Last Name:VIAU COLINDRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7767 ELM CREEK BLVD N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7041
Mailing Address - Country:US
Mailing Address - Phone:612-813-6000
Mailing Address - Fax:
Practice Address - Street 1:7767 ELM CREEK BLVD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7041
Practice Address - Country:US
Practice Address - Phone:612-813-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0009208000000X, 2080P0205X
MN749902080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24935751Medicaid