PEDIATRIC SURGICAL ASSOCIATES LTD NPI 1093778292

NPI Information

NPI: 1093778292
Provider Name: PEDIATRIC SURGICAL ASSOCIATES LTD
Classification: Surgery - 2086S0120X
Specialization: Pediatric Surgery
Entity Type: Organization
CLIA Number: 24D2008373
Address: 2530 CHICAGO AVE
SUITE 550
MINNEAPOLIS, MN
ZIP 55404
Phone: (612) 813-8000

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NPI Details

PEDIATRIC SURGICAL ASSOCIATES LTD is a pediatric surgery surgery in Minneapolis, MN. The provider is a surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. PEDIATRIC SURGICAL ASSOCIATES LTD NPI is 1093778292. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2530 CHICAGO AVE
SUITE 550
MINNEAPOLIS, MN
ZIP 55404-289
Phone: (612) 813-8000
Fax: (612) 813-8005

The provider's authorized official is Paul Louiselle .
The authorized official title is Executive Director and has the following contact phone number (612) 813-8006.

The CLIA number assigned to this NPI record is 24D2008373 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/10/2006 and was last updated on 6/9/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0120X	Surgery	Pediatric Surgery			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	360710100	MEDICAID	MINNESOTA
2	01176	MEDICARE ID-TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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