Individual
DMITRIY SHCHEGOLEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14346 WILSON DR, EDEN PRAIRIE, MN 55347-4179
(612) 250-1929
Mailing address
14346 WILSON DR, EDEN PRAIRIE, MN 55347-4179
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
587208
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24
—
MS
Enumeration date
04/14/2020
Last updated
04/14/2020
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