Provider Demographics
NPI:1710933486
Name:FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
Entity Type:Organization
Organization Name:FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KARULF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-312-1500
Mailing Address - Street 1:393 DUNLAP ST N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4200
Mailing Address - Country:US
Mailing Address - Phone:651-312-1500
Mailing Address - Fax:651-312-1595
Practice Address - Street 1:2805 CAMPUS DR
Practice Address - Street 2:SUITE 405
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:651-312-1717
Practice Address - Fax:763-383-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03775Medicare ID - Type Unspecified