Basic Information
| Provider Information | |||||||||
| NPI: | 1285671263 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED ORTHOPAEDIC SURGERY, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6633 BRENDEN CT | ||||||||
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| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553177560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524702231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1805 HENNEPIN AVE N | ||||||||
| Address2: | |||||||||
| City: | GLENCOE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553361416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3208643121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GREGERSON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | CONRAD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9524702231 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.