Provider Demographics
NPI:1679065205
Name:FUNES HERNANDEZ, MARIO RICARDO (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:RICARDO
Last Name:FUNES HERNANDEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVENUE
Practice Address - Street 2:MEDICAL OFFICE BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1400
Practice Address - Country:US
Practice Address - Phone:612-672-4202
Practice Address - Fax:612-672-4244
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2024-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN75557207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology