Provider Demographics
NPI:1740462324
Name:GRYSKIEWICZ TWIN CITIES COSMETIC SURGERY
Entity type:Organization
Organization Name:GRYSKIEWICZ TWIN CITIES COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRYSKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-435-0177
Mailing Address - Street 1:303 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4522
Mailing Address - Country:US
Mailing Address - Phone:952-435-0177
Mailing Address - Fax:952-435-6287
Practice Address - Street 1:303 E NICOLLET BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4522
Practice Address - Country:US
Practice Address - Phone:952-435-0177
Practice Address - Fax:952-435-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN284022086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty