Provider Demographics
NPI:1710920277
Name:SIGMOND, MARK BEVERS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BEVERS
Last Name:SIGMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6600 FRANCE AVE S
Mailing Address - Street 2:SUITE 605
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1805
Mailing Address - Country:US
Mailing Address - Phone:952-915-8322
Mailing Address - Fax:952-920-2561
Practice Address - Street 1:6600 FRANCE AVE S
Practice Address - Street 2:SUITE 605
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1805
Practice Address - Country:US
Practice Address - Phone:952-915-8322
Practice Address - Fax:952-920-2561
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN21645207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN679788100Medicaid
MNA96119Medicare UPIN
MN200000083Medicare ID - Type Unspecified