Individual
EDGARDO ABAD CRISOSTOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104
(701) 417-4817
Mailing address
2120 LONDON RD APT 452, DULUTH, MN 55812-2811
(218) 310-4128
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
31499
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
971288700
—
MN
Enumeration date
04/06/2006
Last updated
12/03/2019
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