Provider Demographics
NPI:1013990076
Name:PHELAN, NEIL P (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:P
Last Name:PHELAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14909
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-0909
Mailing Address - Country:US
Mailing Address - Phone:612-870-5557
Mailing Address - Fax:612-870-5857
Practice Address - Street 1:2550 UNIVERSITY AVE WEST
Practice Address - Street 2:SUITE 423 SOUTH
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:612-870-5557
Practice Address - Fax:612-870-5857
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43760207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNRR PTAN P00319631Medicare PIN
MNH41154Medicare UPIN