Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 53260 | MN |
NPI | 1255523320 |
---|---|
Provider Name | Dr. Matthew Brandon Ambrose |
First Address | Minneapolis, MN 55454-1450 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 04/01/2015 |