Individual
DR. THEODORE A LONGINOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-5000
Mailing address
10773 ARTESIAN LN, WOODBURY, MN 55129-5239
(651) 436-6142
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27234
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
609218700
—
MN
Enumeration date
08/31/2006
Last updated
03/11/2021
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