Individual
MR. MICHAEL KELLY MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 DELLWOOD ST S, CAMBRIDGE, MN 55008-1920
(763) 689-7700
(763) 689-7941
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-4813
(612) 262-4194
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R102090-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767043500
—
MN
Enumeration date
10/18/2006
Last updated
07/08/2007
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