Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 47790 | MN |
NPI | 1033188156 |
---|---|
Provider Name | Edward T Su |
First Address | Woodbury, MN 55125-4925 |
Second Address | Vadnais Heights, MN 55127-7135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
926459100 | (05) | MN |
I32691 | (02) | MN |
P00265354 | RAILROAD MEDICARE (01) | MN |