Organization
DIGESTIVE ENDOSCOPY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM CHARLES DUANE JR. MD (PRESIDENT)
(763) 416-0399
Entity
Organization
Contact information
Practice address
17322 91ST AVE N, MAPLE GROVE, MN 55311-5403
(763) 416-0399
(763) 416-0399
Mailing address
5970 ARBOUR AVE, EDINA, MN 55436-2521
(952) 920-6638
(612) 725-2248
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
19698
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033127964
NPI 1
MN
05
—
255716900
—
MN
Enumeration date
05/02/2012
Last updated
05/02/2012
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