Organization
MILLENNIUM NEUROSURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHUDHIPHORN THIENPRASIT MD (PRESIDENT)
(651) 748-1461
Entity
Organization
Contact information
Practice address
1675 BEAM AVE, SUITE 215, MAPLEWOOD, MN 55109-1172
(651) 748-1461
Mailing address
1675 BEAM AVE, SUITE 215, MAPLEWOOD, MN 55109-1172
(651) 748-1461
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1473
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN3928
RAILROAD MEDICARE
MN
Enumeration date
07/25/2006
Last updated
12/05/2007
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