Provider Demographics
NPI:1770548166
Name:CARDIAC SURGEONS OF SAINT PAUL
Entity type:Organization
Organization Name:CARDIAC SURGEONS OF SAINT PAUL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LILLEHEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-330-3656
Mailing Address - Street 1:280 SMITH AVE N
Mailing Address - Street 2:SUITE311
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2424
Mailing Address - Country:US
Mailing Address - Phone:651-330-3656
Mailing Address - Fax:651-340-1160
Practice Address - Street 1:280 SMITH AVE N STE 311
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2465
Practice Address - Country:US
Practice Address - Phone:651-330-3656
Practice Address - Fax:651-340-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty