Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | TRN19373 | FL |
Y | 2080P0208X | Pediatric Infectious Diseases | 66071 | MN |
NPI | 1306286786 |
---|---|
Provider Name | Michael Edzards |
First Address | Minneapolis, MN 55404-4518 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 31/07/2019 |