# WOODBURY ENDOCRINOLOGY AND DIABETES CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841964277
- **Authorized official:** DR. ABEL ALFONSO DO (CEO)
- **Authorized official phone:** (612) 425-0958

## Contact information

- **Practice address:** 539 BIELENBERG DR STE 120, WOODBURY, MN 55125-4437
- **Practice address phone:** (612) 425-0958
- **Practice address fax:** (651) 340-4233
- **Mailing address:** 539 BIELENBERG DR STE 120, WOODBURY, MN 55125-4437
- **Mailing address phone:** (612) 425-0958
- **Mailing address fax:** (651) 340-4233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/09/2021
- **Last updated:** 03/04/2022