Provider Demographics
NPI:1265788459
Name:MINNESOTA SPINE ASSOCIATES
Entity type:Organization
Organization Name:MINNESOTA SPINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-474-9729
Mailing Address - Street 1:825 NICOLLET MALL STE 1453
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2703
Mailing Address - Country:US
Mailing Address - Phone:612-293-3800
Mailing Address - Fax:612-293-3759
Practice Address - Street 1:333 WASHINGTON AVE N STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1353
Practice Address - Country:US
Practice Address - Phone:612-293-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN447937400027208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty