State of Minnesota Dba Form - Excel
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State of Minnesota Dba Form document sample
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State of Minnesota Payments to Practitioners Reporting Form - 2008
Wholesaler/Manufacturer Name Pfizer Inc
Wholesaler/Manufacturer Address 235 East 42nd Street, New York, NY 10017
Minnesota License Number 459566-3
Name of Individual Completing Report Humberto Leon, Corp Counsel
Phone number 212-733-0066
Background information and instructions: Minnesota Statutes require wholesale drug distributors and manufacturers to file with the Board of Pharmacy an annual report identifying certain payments made to practitioners. (Practitioners are those licensed health professsionals who are
authorized to prescribe drugs. Pharmacists are not practitioners). The payments that must be reported include: honoraria and payments for expenses of a practitioner who serves as a speaker at a professional or educational conference or meeting; and compensation for substantial
professional or consulting services of a practitioner working on a genuine research project. (See Minnesota Statutes 151.461 and 151.47). The report must identify the specific reason for payments totalling $100 or more. In the column marked "Specific reason for payment",
please list the reason for the payment. (e.g. "honoraria and expenses for speaking", "payment for research consultation", etc.). Do not list general reasons (e.g. "payments for consultation", "payments for services rendered"). Reports filed under this provision are public
data. Reports must be filed in an electronic format, so please fill out this spreadsheet and return it to the Board either attached to an e-mail (Pharmacy.Board@state.mn.us) or copied onto a CD-ROM.
Professional designation ADDRESS OF PRACTITIONER PAYMENT INFORMATION
LAST NAME OF PRACTITIONER FIRST NAME OF PRACTITIONER
(e.g. MD), if any
Street Address City State Zip Code Value of Payment Specific reason for payment
Speaking Fee and related
Aaronson Michael MD 20 2ND ST NE UNIT 509
Minneapolis MN 55413 $26,477.30 expenses
Speaking Fee and related
expenses; Professional Consulting
Ahluwalia Jasjit MD 5036 BRUCE AVE Minneapolis MN 55424 $26,855.15 Fees and related expenses
Speaking Fee and related
expenses; Professional Consulting
Altafullah Irfran MD Long
2520 THOROUGHBRED LNLake MN 55356 $4,649.58 Fees and related expenses
Speaking Fee and related
Anderholm David MD Nisswa
23312 DUTCHMANS BLF MN 56468 $3,592.33 expenses
Speaking Fee and related
Andrews James DO Fergus Falls
624 N WOODLAND DR MN 56537 $3,892.85 expenses
Speaking Fee and related
Baken Leslie MD 4316 GLENCREST RDMinneapolis MN 55416 $2,128.03 expenses
Speaking Fee and related
Bambenek Gregory MD 703
325 S LAKE AVE STE Duluth MN 55802 $125.97 expenses
Speaking Fee and related
Bank Alan MD SMITH AVE N Saint Paul MN 55102 $1,000.00 expenses
Speaking Fee and related
Beaver Gary DO 400 E 3RD ST Duluth MN 55805 $5,294.86 expenses
Speaking Fee and related
expenses; Professional Consulting
Belgrade Miles MD Minneapolis
PAIN MANAGEMENT CENTER MN 55454 $12,368.45 Fees and related expenses
Speaking Fee and related
Bentz Steven MD Minneapolis
10218 MISSISSIPPI BLVD NW MN 55433 $631.06 expenses
Speaking Fee and related
Berger Ines MD 2863 24TH ST NW Rochester MN 55901 $375.09 expenses
Speaking Fee and related
Billups Kevin MD 5505 DUFFERIN DR Savage MN 55378 $7,163.64 expenses
Speaking Fee and related
Boelter Christopher MD Sartell
ADULT & PED. UROLOGY MN 56377 $2,509.55 expenses
Speaking Fee and related
expenses; Research Consulting
Brown David MD Minneapolis
910 E 26TH ST STE 325 MN 55404 $2,015.87 Fees and related expenses
Speaking Fee and related
Butwinick Conrad MD LN
12400 HUNTINGDON Hopkins MN 55305 $2,771.05 expenses
Speaking Fee and related
Canoniero Mariana MD 221 1ST AVE NE APT Minneapolis
33 MN 55413 $1,250.00 expenses
Speaking Fee and related
Colon Pastor MD 46 EVERGREEN RD Saint Paul MN 55110 $2,042.67 expenses
Professional Consulting Fees and
Cook Bryan MD 7066 STILLWATER BLVD NPaul
Saint MN 55128 $183.96 related expenses
Speaking Fee and related
Dudek Arkadiusz MD 4411 MEADOWOOD CIR Paul
Saint MN 55127 $18,617.25 expenses
Speaking Fee and related
expenses; Professional Consulting
Duprez Daniel MD 7015 LANHAM LN Minneapolis MN 55439 $10,415.57 Fees and related expenses
Speaking Fee and related
El-Halawani Samy MD Saint Paul
11035 SWEETWATER PATH MN 55129 $3,966.08 expenses
Speaking Fee and related
Erhard Mark MD 20660 LINWOOD RD Excelsior MN 55331 $3,030.49 expenses
Speaking Fee and related
Gerten Kimberly MD 121 ASHLEY RD Hopkins MN 55343 $1,012.43 expenses
Speaking Fee and related
expenses; Professional Consulting
Goad Eric MD 5904 VIEW LN Minneapolis MN 55436 $4,357.98 Fees and related expenses
Speaking Fee and related
Graham Kevin MD Minneapolis
920 E 28TH ST STE 300 MN 55407 $4,175.95 expenses
Speaking Fee and related
Greatens Todd MD 13495 ELDER DRIVE Brainerd MN 56401 $1,008.34 expenses
Professional Consulting Fees and
Grimm Richard MD PO BOX 19619 Minneapolis MN 55419 $10,147.38 related expenses
Speaking Fee and related
Groat Ronald MD Minnetonka
15320 MINNETONKA BLVD MN 55345 $573.58 expenses
Speaking Fee and related
Groeschel Ana MD 6561 DEERWOOD LNCircle Pines MN 55014 $3,199.68 expenses
Professional Consulting Fees and
Grothey Axel MD Rochester
819 FOX POINTE LN SW MN 55902 $104.30 related expenses
Speaking Fee and related
Hadley Stephen MD Duluth
4000 EAST FIRST STREET MN 55807 $1,710.37 expenses
Speaking Fee and related
Handa Kushal MD 1233 34TH ST NW Bemidji MN 56601 $15,651.65 expenses
Professional Consulting Fees and
Hays J Taylor MD Rochester
3239 FOX HOLLOW LN SW MN 55902 $116.89 related expenses
Speaking Fee and related
Heiring Jessica MD 2046 ACORN CIR Wayzata MN 55391 $2,000.00 expenses
Speaking Fee and related
Hendrickson Paul MD Frazee
50737 E LAKE SEVEN RD MN 56544 $2,024.56 expenses
Speaking Fee and related
Henry Stephen MD 610 30TH AVE W Alexandria MN 56308 $440.59 expenses
Speaking Fee and related
Henry William MD 701 PARK AVE #P5 Minneapolis MN 55415 $2,730.72 expenses
Speaking Fee and related
Hess Todd MD 1724 COLFAX AVE S Minneapolis MN 55403 $185,016.30 expenses
Speaking Fee and related
expenses; Professional Consulting
Hoffman Neil MD 9809 STJOHNS RD. Minnetonka MN 55305 $3,047.50 Fees and related expenses
Speaking Fee and related
Hoiland Christa MD 11993 285TH ST Lindstrom MN 55045 $798.35 expenses
Speaking Fee and related
Holth Byron MD 11269 JEFFERSON HWY N
Champlin MN 55316 $750.00 expenses
Speaking Fee and related
expenses; Professional Consulting
Hurt Richard MD Rochester
2320 TELEMARK LN NW MN 55901 $20,064.85 Fees and related expenses
Speaking Fee and related
Ingenito Allan MD 5280 161ST AVE NW Anoka MN 55303 $3,410.84 expenses
Speaking Fee and related
Kamman Lee MD S
2219 HIGH POINTE RDaint Paul MN 55120 $3,014.85 expenses
Speaking Fee and related
Kassamali Jamal MD 604 9TH ST N Virginia MN 55792 $3,013.13 expenses
Speaking Fee and related
Katz Harold MD 3990 TROTTERS CT Saint Paul MN 55123 $1,520.01 expenses
Speaking Fee and related
Keenan Joseph MD Minneapolis
1505 HAMPSHIRE AVE N MN 55427 $2,074.21 expenses
Speaking Fee and related
Kemberling Jason MD 7953 S BAY CURV Eden Prairie MN 55347 $1,344.33 expenses
Speaking Fee and related
Khan Asim MD 2850 WESTRIDGE RDHopkins MN 55305 $4,091.43 expenses
Speaking Fee and related
Khan Muhammad MD 483 POPLAR DR Saint Paul MN 55126 $3,022.53 expenses
Speaking Fee and related
Khetarpal Suneel MD RD
8200 MARSH CREEK Saint Paul MN 55125 $2,195.28 expenses
Speaking Fee and related
Kline Susan MD 2269 HILLSIDE AVE Saint Paul MN 55108 $3,732.66 expenses
Speaking Fee and related
expenses; Professional Consulting
Knudson Dean MD Minneapolis
2320 BROOKRIDGE AVE MN 55422 $7,841.42 Fees and related expenses
Speaking Fee and related
Kolodny Luciano MD 2587 ALPINE DR Saint Paul MN 55125 $3,177.24 expenses
Speaking Fee and related
Kriegler Samuel MD V
901 9TH ST N STE 315 irginia MN 55792 $1,063.96 expenses
Speaking Fee and related
Locketz Adam MD Saint Paul
2140 VERMILLION BAY MN 55129 $3,198.08 expenses
Speaking Fee and related
Mcevoy Charlene MD 382 WINSLOW AVE Saint Paul MN 55107 $5,500.00 expenses
Speaking Fee and related
expenses; Research Consulting
Miller Bradley MD 6728 PARTRIDGE PL Circle Pines MN 55014 $1,688.56 Fees and related expenses
Professional Consulting Fees and
Mohan Sushila MD RD
8675 VALLEY CREEK Saint Paul MN 55125 $1,183.96 related expenses
Speaking Fee and related
Morrison Vicki MD 4155 NORMA AVE Saint Paul MN 55112 $20,375.23 expenses
Professional Consulting Fees and
Nehra Ajay MD Rochester
5360 WEATHERHILL DR SW MN 55902 $2,263.50 related expenses
Speaking Fee and related
Olson Jennifer MD 2700 SYLVAN RD S Hopkins MN 55305 $1,015.47 expenses
Professional Consulting Fees and
Olson Robert MD 120 CHANCERY LN Mankato MN 56001 $183.96 related expenses
Speaking Fee and related
Orr William MD S
3537 GREAT OAKS PL aint Paul MN 55123 $10,669.78 expenses
Speaking Fee and related
Parry Gareth MD Minneapolis
516 DELAWARE ST SE RM 4-100 MN 55455 $2,646.83 expenses
Speaking Fee and related
Penovich Patricia MD RD
344 SALEM CHURCH Saint Paul MN 55118 $1,507.28 expenses
Speaking Fee and related
expenses; Professional Consulting
Philander Dennis MD 35 HIGHVIEW PL Minneapolis MN 55419 $1,933.96 Fees and related expenses
Professional Consulting Fees and
Qureshi Adhan MD - NEUROLOGY
UNIV OF MINNESOTAMinneapolis MN 55455 $4,260.11 related expenses
Research Consulting Fees and
Reeve Elizabeth MD Minneapolis
4800 HAMPSHIRE AVE N MN 55428 $106.67 related expenses
Speaking Fee and related
Retterath Patrick MD 13000 180TH AVE NENew London MN 56273 $104.29 expenses
Speaking Fee and related
expenses; Professional Consulting
Rhame Frank MD 401 S 1ST ST UNIT 702
Minneapolis MN 55401 $5,250.06 Fees and related expenses
Speaking Fee and related
Rice Kathryn MD 4769 HAUGE CIR Saint Paul MN 55122 $6,182.13 expenses
Speaking Fee and related
expenses; Professional Consulting
Rogin Joanne MD LN
2211 AUSTRIAN PINEHopkins MN 55305 $45,331.60 Fees and related expenses
Speaking Fee and related
Ross Robert MD 435 EASTVOLD AVE Ortonville MN 56278 $2,378.78 expenses
Speaking Fee and related
Ruegemer J Jeffrey MD Excelsior
5105 GREENWOOD CIR MN 55331 $1,515.15 expenses
Professional Consulting Fees and
Samuelson Thomas MD 4700 OLD KENT RD Excelsior MN 55331 $1,551.06 related expenses
Speaking Fee and related
Schapiro Randall MD 4295 WESTON WAY Saint Paul MN 55126 $52,393.78 expenses
Speaking Fee and related
Schmitz John MD 2010 25TH ST S Saint Cloud MN 56301 $2,018.74 expenses
Professional Consulting Fees and
Seaquist Elizabeth MD 4751 DUPONT AVE S Minneapolis MN 55419 $2,058.01 related expenses
Speaking Fee and related
Simons Derek MD Minneapolis
13235 58TH AVE N APT G MN 55442 $1,000.00 expenses
Speaking Fee and related
expenses; Professional Consulting
Sipahimalani Anil MD 8359 RED OAK DR Saint Paul MN 55112 $2,322.17 Fees and related expenses
Professional Consulting Fees and
Sit Arthur MD 200 1ST ST SW Rochester MN 55905 $5,220.00 related expenses
Speaking Fee and related
Sivanna Panjini MD 1720 HIGHWAY 59 S Thief River Falls MN 56701 $5,586.23 expenses
Speaking Fee and related
expenses; Professional Consulting
Smick Annette MD 100 GLADIOLA DR Saint Charles MN 55972 $12,991.67 Fees and related expenses
Speaking Fee and related
Sovell Chase MD STE 200
6525 FRANCE AVE S Minneapolis MN 55435 $1,006.34 expenses
Speaking Fee and related
Starchook Constanti MD S
852 GREAT OAKS TRL aint Paul MN 55123 $2,898.73 expenses
Professional Consulting Fees and
Steckelberg James MD 1867 SUMMIT DR NE Rochester MN 55906 $3,323.70 related expenses
Speaking Fee and related
Stillman M. Thomas MD H
9800 SAINT JOHNS RDopkins MN 55305 $23,427.36 expenses
Speaking Fee and related
expenses; Professional Consulting
Stillman Martin MD 2671 INGLEWOOD AVE S
Minneapolis MN 55416 $20,970.30 Fees and related expenses
Speaking Fee and related
Stockman Michael MD 9982 INDIGO DR Eden Prairie MN 55347 $1,568.54 expenses
Professional Consulting Fees and
Straka Robert PHA 834 BALD LAKE CT Saint Paul MN 55123 $894.90 related expenses
Speaking Fee and related
expenses; Professional Consulting
Strinden Steven MD 209 2ND ST NE Barnesville MN 56514 $5,527.93 Fees and related expenses
Speaking Fee and related
expenses; Professional Consulting
Sutherland Suzette MD 3801 HUNTINGDON DR
Hopkins MN 55305 $15,565.44 Fees and related expenses
Speaking Fee and related
Varma Sujit MD 2609 7TH AVE E Hibbing MN 55746 $1,045.07 expenses
Speaking Fee and related
expenses; Professional Consulting
Vine Craig MD Saint Paul
2550 UNIVERSITY AVE W STE 229N MN 55114 $24,409.03 Fees and related expenses
Speaking Fee and related
Winegarden Thomas MD 18762 ERIN BAY Eden Prairie MN 55347 $1,016.73 expenses
Speaking Fee and related
Wirtz Jason MD 3039 40TH AVE S Minneapolis MN 55406 $750.00 expenses Consulting Fees and
Professional
related expenses; Research
Wyman Jean NUR Excelsior
5955 BOULDER BRIDGE LN MN 55331 $8,443.15 Consulting Fees and related
Speaking Fee and related
Xie Kevin MD Sartell
903 MORNING STAR CT MN 56377 $3,257.36 expenses
Professional Consulting Fees and
Yee Douglas MD Saint Paul
434 MISSISSIPPI RIVER BLVD S MN 55105 $4,210.65 related expenses
Speaking Fee and related
Zadeii Gino MD 4 TROON CT Saint Paul MN 55110 $2,416.10 expenses
Research Consulting Fees and
ADULT & PEDIATRIC UROLOGY PLLP UNSPI 2351 CONNECTICUT AVENUE S SUITE 200
SARTELL MN 56377 $11,751.00 related expenses
Research Consulting Fees and
KIDNEY SPECIALISTS OF MINNESOTA PA UNSPI DBA TWIN CITIES CLINICAL RSCH 6200 SHINGLE CREEK PKWY SUITE 300 $32,894.07
BROOKLYN CTR MN 55430 related expenses
Research Consulting Fees and
MINNEAPOLIS CLINIC OF NEUROLOGY LTD UNSPI 4225 GOLDEN VALLEY ROAD VALLEY
GOLDEN MN 55422 $25,000.00 related expenses
Research Consulting Fees and
MINNESOTA GASTROENTEROLOGY PA UNSPI ATTN ROSEMARY GOLT P O BOX 14909 MN
MINNEAPOLIS 55414 $5,272.00 related expenses
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