ECHELON SURGICAL SPECIALISTS LLC (NPI# 1720574445) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720574445 |
| Entity Type | Organization |
| Organization Name | ECHELON SURGICAL SPECIALISTS LLC |
| Practice Address |
15450 Highway 7 Ste 225 Minnetonka MN 55345-3522 |
| Mailing Address |
12300 168th St W Lakeville MN 55044-9224 |
| Practice Telephone | 5073833134 |
| Mailing Telephone | 5073833134 |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2018-10-02 |
| Authorized Official Name | DR. MATTHEW CARROLL CAMP (CEO) |
| Authorized Official Telephone | 5073833134 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | 54799 | MN | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2934 W 66th St, Edina, MN 554231939 | 5073833134 |
| Street Address |
15450 HIGHWAY 7 STE 225 |
| City | MINNETONKA |
| State | MN |
| Zip Code | 55345-3522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417587205 | Pain Partners LLC | Pharmacist | 15225 Wild Wings Court, Minnetonka, MN 55345 | 2020-01-21 |
| 1356811608 | Caitlin Marie Peterson | Specialist/Technologist | 15708 Wood Knoll Lane, Minnetonka, MN 55345 | 2018-11-29 |
| 1649747007 | West Side Counseling LLC | Community/Behavioral Health | 10520 Wayzata Blvd., Suite 100, Minnetonka, MN 55345 | 2018-10-24 |
| 1689173247 | Theresa Tsuchiya | Psychologist | Relate, Inc., 5125 County Road 101, Suite 300, Minnetonka, MN 55345 | 2018-02-08 |
| 1497264147 | Minnetonka Assisted Living and Hospice | Community Health Worker | 14667 Lake Street Extension, Minnetonka, MN 55345 | 2017-09-26 |
| 1619494671 | Shree Revenue Management | Durable Medical Equipment & Medical Supplies | 6117, Creek Ridge Ct, Minnetonka, MN 55345 | 2017-08-29 |
| 1538606876 | Stefani Yanizeski | Speech-Language Pathologist | Minnesota Autism Center, 5710 Baker Road, Minnetonka, MN 55345 | 2017-01-25 |
| 1790157469 | Greg Anderson | Psychologist | 5125 County Road 101, #300, Relate, Inc., Minnetonka, MN 55345 | 2015-10-21 |
| 1861896375 | Kristine L Smith | Marriage & Family Therapist | 5125 County Road 101 Suite 300, Minnetonka, MN 55345 | 2014-10-13 |
| 1982014460 | Miranda Jean Johnson | Speech-Language Pathologist | 15265 Minnetonka Blvd., Minnetonka, MN 55345 | 2014-05-06 |
| Find all providers in zip 55345 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699862490 | Pawel P Stachowicz | Plastic Surgery | 2000 Plymouth Rd # 260, Minnetonka, MN 55305-2366 | 2006-10-05 |
| 1205939618 | Adam Lokeh | Plastic Surgery | 13911 Ridgedale Dr. #395, Minnetonka, MN 55305 | 2006-09-07 |
| 1922358514 | Authentic Plastic Surgery, LLC | Plastic Surgery | 2000 Plymouth Road, Suite 300, Minnetonka, MN 55305-2335 | 2012-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104252022 | Bashioum Cosmetic Surgery Center, Ltd. | Plastic Surgery | 445 Lake St E Ste 210, Wayzata, MN 55391-1671 | 2013-09-24 |
| 1184994501 | James Jerome Diehl | Plastic Surgery | 10530 W Riverview Dr, Eden Prairie, MN 55347-4921 | 2012-01-02 |
| 1851690697 | Jason Dean Fowler | Plastic Surgery | 1420 London Rd Ste 101, Duluth, MN 55805-2437 | 2011-03-18 |
| 1093049348 | Harry Alvin Johnson Jr. | Plastic Surgery | 4708 Townes Road, Edina, MN 55424 | 2009-09-18 |
| 1013151430 | Jennifer Ann Cameron | Plastic Surgery | 310 Smith Ave N Ste 330, Saint Paul, MN 55102 | 2009-04-29 |
| 1538336938 | Oscar Javier Manrique Mogollon | Plastic Surgery | 5347 Scenic Oak Dr Sw, Rochester, MN 55902-2567 | 2008-05-14 |
| 1558533919 | David O. Smith | Plastic Surgery | 6545 France Ave S Ste 505, Edina, MN 55435-2116 | 2008-03-26 |
| 1447442702 | Sue-mi C Tuttle | Plastic Surgery | 401 Phalen Blvd-ms 41104h, Healthpartners Specialty Center 401, St. Paul, MN 55130-5302 | 2007-08-10 |
| 1033314943 | Tracy So Kayan | Plastic Surgery | 2805 Campus Dr Ste 485, Plymouth, MN 55441-2919 | 2007-06-19 |
| 1710022363 | Peter Andrew Vogt | Plastic Surgery | 319 Barry Ave S, #300, Wayzata, MN 55391-1658 | 2007-02-21 |
| Find all providers with the same taxonomy | ||||
| City | MINNETONKA |
| Zip Code | 55345 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.