Provider Demographics
NPI:1679542070
Name:MESNA, GREGORY TODD (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TODD
Last Name:MESNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7407 WAYZATA BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:952-927-4556
Mailing Address - Fax:952-897-1360
Practice Address - Street 1:7407 WAYZATA BLVD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-927-4556
Practice Address - Fax:952-897-1360
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN35064208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00088815OtherRAILROAD MEDICARE
MN01020301OtherPREFERRED ONE
MN13-11226OtherMEDICA
MN652888100Medicaid
MN109283OtherUCARE
MN24T91MEOtherBLUE CROSS INDIV
MN24T90SOOtherBLUE CROSS GROUP
MNMN652888100Medicaid
F44426Medicare UPIN
240000124Medicare UPIN