Provider Demographics
NPI:1538173406
Name:FERRER, EUSEBIO EMMANUEL SERRANO (MD)
Entity type:Individual
Prefix:
First Name:EUSEBIO EMMANUEL
Middle Name:SERRANO
Last Name:FERRER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:14655 GALAXIE AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8602
Practice Address - Country:US
Practice Address - Phone:651-241-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57209207R00000X
WI55491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19227Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID
WI201950739Medicare PIN
IL211928Medicare ID - Type UnspecifiedGROUP MEDICARE ID
ILI35211Medicare UPIN
P00909087OtherRR MEDICARE