Provider Demographics
NPI:1730112053
Name:MKMD NEUROSURGERY, PLLC
Entity type:Organization
Organization Name:MKMD NEUROSURGERY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:YUN-MI
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-542-8888
Mailing Address - Street 1:9325 UPLAND LN N STE 205
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4474
Mailing Address - Country:US
Mailing Address - Phone:763-542-8888
Mailing Address - Fax:763-542-8899
Practice Address - Street 1:9325 UPLAND LN N STE 205
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4474
Practice Address - Country:US
Practice Address - Phone:763-542-8888
Practice Address - Fax:763-542-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1628446-2207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH30308Medicare UPIN