Organization
HENNEPIN FACULTY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE R FOSBURY (PRESIDENT)
(612) 347-5109
Entity
Organization
Contact information
Practice address
914 S 8TH ST, S4, MINNEAPOLIS, MN 55404-1210
(612) 347-6450
Mailing address
914 S 8TH ST, S600, MINNEAPOLIS, MN 55404-1210
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142712100
—
MN
Enumeration date
06/02/2006
Last updated
09/24/2008
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