| Derek Prowe Llc | |
|
4749 Chicago Ave Suite 1d Minneapolis MN 55407-3556 | |
| (612) 656-9122 | |
| Not Available |
| Full Name | Derek Prowe Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4749 Chicago Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Derek Evan Prowe (OWNER) |
| Authorized Official Contact | 6126569122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Derek Prowe Llc 4749 Chicago Ave Suite 1d Minneapolis MN 55407-3556 Ph: (612) 656-9122 | Derek Prowe Llc 4749 Chicago Ave Suite 1d Minneapolis MN 55407-3556 Ph: (612) 656-9122 |
| NPI Number | 1083074371 |
|---|---|
| Provider Enumeration Date | 02/29/2016 |
| Last Update Date | 02/29/2016 |
| Medicare PECOS PAC ID | 9436455185 |
|---|---|
| Medicare Enrollment ID | O20160307002662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083074371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP5238 (Minnesota) | Primary |
| Provider Name | Derek E Prowe |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699924639 PECOS PAC ID: 0345546099 Enrollment ID: I20160519001238 |
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