Provider Demographics
NPI:1184722464
Name:INFECTIOUS DISEASES-MINNEAPOLIS-LTD
Entity type:Organization
Organization Name:INFECTIOUS DISEASES-MINNEAPOLIS-LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:SCHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-520-4320
Mailing Address - Street 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3183
Mailing Address - Country:US
Mailing Address - Phone:763-520-4320
Mailing Address - Fax:763-520-7055
Practice Address - Street 1:5700 BOTTINEAU BOULEVARD
Practice Address - Street 2:SUITE 270
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55429-3183
Practice Address - Country:US
Practice Address - Phone:763-520-4320
Practice Address - Fax:763-520-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN834207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN558270900Medicaid
MNC03238Medicare ID - Type Unspecified