Provider Demographics
NPI:1255414058
Name:REMAFEDI, GARY J (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:REMAFEDI
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-4260
Mailing Address - Fax:
Practice Address - Street 1:KDWB UNIVERSITY PEDIATRICS FAMILY CENTER
Practice Address - Street 2:200 OAK STREET SE, SUITE 160
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27967208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN768320OtherARAZ
MNHP22003OtherHEALTH PARTNERS
MN1009288OtherPREFERRED ONE
MN1224532OtherMEDICA CHOICE
IA0990564Medicaid
MN1270261OtherMEDICA PRIMARY
MN100935OtherUCARE
MN1009288OtherPREFERRED ONE