Provider Demographics
NPI:1881632297
Name:MINNEAPOLIS OTOLARYNGOLOGY PA
Entity Type:Organization
Organization Name:MINNEAPOLIS OTOLARYNGOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-920-4595
Mailing Address - Street 1:6525 FRANCE AVE S
Mailing Address - Street 2:SUITE 325
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2148
Mailing Address - Country:US
Mailing Address - Phone:952-920-4595
Mailing Address - Fax:952-920-7958
Practice Address - Street 1:6525 FRANCE AVE S
Practice Address - Street 2:SUITE 325
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2148
Practice Address - Country:US
Practice Address - Phone:952-920-4595
Practice Address - Fax:952-920-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00272Medicare ID - Type Unspecified