Individual
MARIA DE LOURDES AZEVEDO GOMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
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, STE 10, PLYMOUTH, MN 55441-2645
(763) 559-2171
(763) 694-9000
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
40553
MN
2085N0904X
Nuclear Radiology Physician
40553
MN
2085R0202X
Diagnostic Radiology Physician
Primary
40553
MN
2085R0204X
Vascular & Interventional Radiology Physician
40553
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
993017500
—
MN
Enumeration date
07/29/2005
Last updated
06/26/2012
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