Individual
BRIAN J DE MICHAELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3300 OAKDALE AVE N, ROBBINSDALE, MN 55422-2926
(763) 559-2171
(763) 694-9000
Mailing address
2800 CAMPUS DR, #10, PLYMOUTH, MN 55441-2645
(763) 559-2171
(763) 694-9000
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
42494
MN
2085N0700X
Neuroradiology Physician
42494
MN
2085N0904X
Nuclear Radiology Physician
42494
MN
2085R0202X
Diagnostic Radiology Physician
Primary
42494
MN
2085U0001X
Diagnostic Ultrasound Physician
42494
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300405800
—
MN
Enumeration date
07/29/2005
Last updated
03/03/2009
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