| Ethan Prince, | |
|
3600 Minnesota Dr Ste 800, Edina, MN 55435-7915 | |
| (952) 595-1100 | |
| Not Available |
| Full Name | Ethan Prince |
|---|---|
| Gender | Male |
| Speciality | Radiology - Vascular & Interventional Radiology |
| Location | 3600 Minnesota Dr Ste 800, Edina, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306064563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | MD12864 (Rhode Island) | Secondary |
| 2085R0204X | Radiology - Vascular & Interventional Radiology | 12864 (Rhode Island) | Primary |
| Entity Name | Virtual Radiologic Professionals LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932342029 PECOS PAC ID: 4981608817 Enrollment ID: O20110802000022 |
| Mailing Address | Practice Location Address |
|---|---|
| Ethan Prince, 3600 Minnesota Dr Ste 800, Edina, MN 55435-7915 Ph: (952) 595-1100 | Ethan Prince, 3600 Minnesota Dr Ste 800, Edina, MN 55435-7915 Ph: (952) 595-1100 |
Christopher Calixte, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3600 Minnesota Dr Ste 800, Edina, MN 55435 Phone: 952-595-1100 Fax: 612-294-4903 |
Paul D Guisler, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3600 Minnesota Dr Ste 800, Edina, MN 55435 Phone: 952-595-1301 Fax: 612-294-4903 |
Krishna Vaidyanathan Iyer, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 3600 Minnesota Dr Ste 800, Edina, MN 55435 Phone: 952-595-1100 |
Rati Narendra Patel, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3600 Minnesota Dr Ste 800, Edina, MN 55435 Phone: 952-595-1301 Fax: 612-294-4903 |
Susanne S. Kim, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 3600 Minnesota Dr Ste 800, Edina, MN 55435 Phone: 952-595-1301 Fax: 612-294-4903 |
Gwendolyn Durgin, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3600 Minnesota Dr Ste 800, Edina, MN 55435 Phone: 952-595-1301 Fax: 612-294-4903 |
Robert L Edwards, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 3600 Minnesota Dr Ste 800, Edina, MN 55435 Phone: 952-595-1100 |