Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 20A9899 | CA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 0009898 | OH |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 59784 | MN |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 67028 | GA |
NPI | 1134321789 |
---|---|
Provider Name | Michael James Priola |
First Address | Woodbury, MN 55125 |
Second Address | Woodbury, MN 55125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 27/08/2020 |