| Cedar Lake Community Clinic Pa | |
|
1831 E Lake St Minneapolis MN 55407-1809 | |
| (612) 276-1000 | |
| (612) 729-1885 |
| Full Name | Cedar Lake Community Clinic Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1831 E Lake St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Kristen L Coulter (PRESIDENT / MEDICAL DIRECTOR) |
| Authorized Official Contact | 6122761000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Lake Community Clinic Pa 1831 E Lake St Minneapolis MN 55407-1809 Ph: (612) 276-1000 | Cedar Lake Community Clinic Pa 1831 E Lake St Minneapolis MN 55407-1809 Ph: (612) 276-1000 |
| NPI Number | 1649582669 |
|---|---|
| Provider Enumeration Date | 07/07/2010 |
| Last Update Date | 02/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649582669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
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