Provider Demographics
NPI:1487602926
Name:PROSAPIO, PHILIP L (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:PROSAPIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3440
Mailing Address - Country:US
Mailing Address - Phone:320-631-2200
Mailing Address - Fax:320-632-3728
Practice Address - Street 1:1108 1ST ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3440
Practice Address - Country:US
Practice Address - Phone:320-631-2200
Practice Address - Fax:320-632-3728
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN31140207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN770763100MNMedicaid
MN200002647Medicare PIN
MN770763100MNMedicaid
MNE99832Medicare UPIN