Provider Demographics
NPI:1780649665
Name:SPECIALISTS IN GENERAL SURGERY, LTD
Entity Type:Organization
Organization Name:SPECIALISTS IN GENERAL SURGERY, LTD
Other - Org Name:SPECIALISTS IN GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-780-6699
Mailing Address - Street 1:9825 HOSPITAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4479
Mailing Address - Country:US
Mailing Address - Phone:763-780-6699
Mailing Address - Fax:763-420-0506
Practice Address - Street 1:9825 HOSPITAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4479
Practice Address - Country:US
Practice Address - Phone:763-780-6699
Practice Address - Fax:763-420-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC00760Medicare ID - Type Unspecified