Individual
MR. MARK DSOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
10709 WAYZATA BLVD STE 200, MINNETONKA, MN 55305-5509
(952) 888-5800
(952) 567-6156
Mailing address
9801 DUPONT AVE S, STE 425, BLOOMINGTON, MN 55431-3873
(952) 888-5800
(952) 567-6176
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11170
MN
363A00000X
Physician Assistant
C04769
MD
Other
Enumeration date
08/07/2012
Last updated
09/15/2020
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