Organization
SURGICAL SPECIALISTS OF MINNESOTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC M JOHNSON MD (PRESIDENT)
(612) 863-7770
Entity
Organization
Contact information
Practice address
2545 CHICAGO AVE, SUITE 601, MINNEAPOLIS, MN 55404-4522
(612) 863-7770
(612) 863-7772
Mailing address
2545 CHICAGO AVE, SUITE 601, MINNEAPOLIS, MN 55404-4522
(612) 863-7770
(612) 863-7772
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116988D147
UCARE
MN
01
—
13T70GR
BLUE CROSS BLUE SHIELD
MN
01
—
1700668
MEDICA
MN
01
—
18390
HEALTHPARTNERS
MN
05
—
224018100
—
MN
01
—
31732900
WISCONSIN MA
MN
Enumeration date
05/05/2006
Last updated
06/15/2015
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