Individual
RANDALL JON COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 PLYMOUTH RD, SUITE 100, MINNETONKA, MN 55305-2366
(763) 581-5250
(763) 581-5257
Mailing address
2000 PLYMOUTH RD, SUITE 100, MINNETONKA, MN 55305-2366
(763) 581-5250
(763) 581-5257
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27678
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
631570400
—
MN
Enumeration date
12/05/2005
Last updated
09/02/2013
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