Provider Demographics
NPI:1871576116
Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-924-8668
Mailing Address - Street 1:6517 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2103
Mailing Address - Country:US
Mailing Address - Phone:952-841-9490
Mailing Address - Fax:952-806-9741
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 600
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-920-2200
Practice Address - Fax:952-920-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01436Medicare ID - Type Unspecified