Provider Demographics
NPI:1952537862
Name:VASQUEZ, CIRO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CIRO
Middle Name:ANTONIO
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MCC 96
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:813-810-8801
Mailing Address - Fax:
Practice Address - Street 1:913 E 26TH ST
Practice Address - Street 2:STE 305 PIPER BLDG
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4515
Practice Address - Country:US
Practice Address - Phone:612-871-7278
Practice Address - Fax:612-863-8531
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN54307207T00000X
390200000X
CODR.0057130207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program