Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 23228 | MN |
NPI | 1114902186 |
---|---|
Provider Name | Dr. Michael B Ainslie |
First Address | St Louis Park, MN 55426-1728 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 03/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
853888300 | (05) | MN |
A95255 | (02) | MN |