Boetticher, Abigail R

Boetticher, Abigail R is an individual health care provider with primary practice located at 2828 Chicago Ave South Suite 200, Minneapolis MN 55407-1320. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is her primary health care specialty. Boetticher, Abigail R can be contacted via phone (612) 879-1000.

Contact Information

Primary practice address
2828 Chicago Ave South Suite 200 Minneapolis MN 55407-1320
Phone: (612) 879-1000
Fax: (612) 879-9116
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology 2084N0402X 46169 Minnesota
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 46169 Minnesota

Profile Details

NPI number 1730152034
LBN Legal business name Boetticher, Abigail R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 8th, 2006
Last updated Oct 7th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730152034 NPPES
Minnesota MEDICAID 871425800

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