Provider Demographics
NPI:1972864742
Name:UNIVERSITY OF MINNESOTA
Entity Type:Organization
Organization Name:UNIVERSITY OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ISAAK
Authorized Official - Last Name:KARACHUNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-626-2499
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 295
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-5001
Mailing Address - Country:US
Mailing Address - Phone:612-626-2499
Mailing Address - Fax:612-625-8488
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 295
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-5001
Practice Address - Country:US
Practice Address - Phone:612-626-2499
Practice Address - Fax:612-625-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47339261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty