Russell Eide, PA-C
Physician Assistant in Minneapolis, MN. Individual provider (NPI-1).
NPI number1366096729
StatusActive
Last updated in NPPESJul 24, 2019
Details
- NPI
- 1366096729
- Entity type
- Individual (NPI-1)
- Name
- Russell Eide
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 24, 2019
- Last updated
- Jul 24, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 1164184 | – | Yes |
Practice location
3300 Oakdale Ave NMinneapolis, MN 55422-2926
Phone 763-520-5200
Mailing address
2986 S Superior StMilwaukee, WI 53207-2544
Phone 715-308-4563
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