Provider Demographics
NPI:1952335960
Name:MULDOWNEY, J BART (MN)
Entity type:Individual
Prefix:
First Name:J
Middle Name:BART
Last Name:MULDOWNEY
Suffix:
Gender:M
Credentials:MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 FRANCE AVE S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4787
Mailing Address - Country:US
Mailing Address - Phone:952-925-1111
Mailing Address - Fax:952-922-3446
Practice Address - Street 1:7450 FRANCE AVE S
Practice Address - Street 2:SUITE 220
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4787
Practice Address - Country:US
Practice Address - Phone:952-925-1111
Practice Address - Fax:952-922-3446
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN274682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240000106Medicare ID - Type Unspecified
MNA96093Medicare UPIN