Provider Demographics
NPI:1649401688
Name:THE MIDWEST C ENTER FOR REPRODUCTIVE HEATLH, P.A.
Entity Type:Organization
Organization Name:THE MIDWEST C ENTER FOR REPRODUCTIVE HEATLH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:763-494-7700
Mailing Address - Street 1:12000 ELM CREEK BLVD N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7073
Mailing Address - Country:US
Mailing Address - Phone:763-494-7700
Mailing Address - Fax:763-494-7706
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 350
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-494-7700
Practice Address - Fax:763-494-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207VE0102X207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3D492OtherBCBS-MN PROVIDER
MNCOR16153OtherBCBS-ND PROVIDER
MN3D491MIOtherBCBS-MN PROVIDER FACILITY
MNE02458OtherUPIN
MNCOR16154OtherBCBS-ND PROVIDER