Individual
PHILLIP L. EDWARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
Mailing address
3100 W LAKE ST, SUITE 210, MINNEAPOLIS, MN 55416-4527
(612) 925-6033
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
19329
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
830593500
MEDICAL ASSISTANCE
MN
Enumeration date
11/29/2006
Last updated
12/20/2013
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