Individual
AN LY CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
909 FULTON ST SE, MINNEAPOLIS, MN 55455-4800
(161) 267-2742
(612) 672-7422
Mailing address
909 FULTON ST SE, MINNEAPOLIS, MN 55455-4800
16126727422
(612) 273-4370
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
60703
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100248470
—
KY
Enumeration date
07/17/2007
Last updated
08/29/2017
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