Organization
MINNESOTA NEUROVASCULAR & SKULL BASE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC S NUSSBAUM MD (OWNER)
(612) 374-0177
Entity
Organization
Contact information
Practice address
3033 EXCELSIOR BLVD, SUITE 403, MINNEAPOLIS, MN 55416-4688
(612) 374-0177
(612) 374-0893
Mailing address
3901 W 25TH ST, SAINT LOUIS PARK, MN 55416-3803
(952) 285-1016
(952) 285-1018
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21266300
—
WI
05
—
77007040
—
SD
Enumeration date
04/04/2007
Last updated
03/27/2008
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