Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 26295 | MN |
NPI | 1003877788 |
---|---|
Provider Name | Noel Pillman |
First Address | Edina, MN 55439 |
Second Address | Coon Rapids, MN 55433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 13/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156763200 | (05) | MN |
26295 | MEDICAL LICENSE (01) | MN |
E57122 | (02) |