Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEN V CONDON (CHIEF FINANCIAL OFFICER)
(763) 586-5839
Entity
Organization
Contact information
Practice address
6401 UNIVERSITY AVE NE, SUITE 200, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008
Mailing address
6401 UNIVERSITY AVE NE, SUITE 200, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
147
MN
207N00000X
Dermatology Physician
147
MN
207Q00000X
Family Medicine Physician
Primary
147
MN
207R00000X
Internal Medicine Physician
147
MN
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
147
MN
207RI0200X
Infectious Disease Physician
147
MN
207V00000X
Obstetrics & Gynecology Physician
147
MN
207W00000X
Ophthalmology Physician
147
MN
207X00000X
Orthopaedic Surgery Physician
147
MN
207Y00000X
Otolaryngology Physician
147
MN
208000000X
Pediatrics Physician
147
MN
2083X0100X
Occupational Medicine Physician
147
MN
208600000X
Surgery Physician
147
MN
208800000X
Urology Physician
147
MN
208M00000X
Hospitalist Physician
147
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02071BR
BCBS OF MN
MN
01
—
1014268
PREF ONE URGENT CARE #
MN
01
—
147
STATE PROF. REGISTRATION
MN
01
—
AQ9091045486
PREFERRED ONE
MN
Enumeration date
05/13/2006
Last updated
11/13/2007
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