Provider Demographics
NPI:1730211863
Name:MINCEP EPILEPSY CARE PA
Entity type:Organization
Organization Name:MINCEP EPILEPSY CARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMNIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-525-4511
Mailing Address - Street 1:5775 WAYZATA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1222
Mailing Address - Country:US
Mailing Address - Phone:952-525-4511
Mailing Address - Fax:952-525-1560
Practice Address - Street 1:5775 WAYZATA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1222
Practice Address - Country:US
Practice Address - Phone:952-525-4511
Practice Address - Fax:952-525-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103730OtherU CARE NUMBER
MN103730OtherU CARE NUMBER