| Minnesota Clinical & Neuropsychological Associates, P.a. | |
|
7800 Metro Pkwy Suite 300 Bloomington MN 55425-1514 | |
| (952) 876-0727 | |
| (952) 851-9618 |
| Full Name | Minnesota Clinical & Neuropsychological Associates, P.a. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 7800 Metro Pkwy, Bloomington, Minnesota |
| Authorized Official Name and Position | Thomas Michael Misukanis (OWNER) |
| Authorized Official Contact | 9528760727 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Minnesota Clinical & Neuropsychological Associates, P.a. 7800 Metro Pkwy Suite 300 Bloomington MN 55425-1514 Ph: (952) 876-0727 | Minnesota Clinical & Neuropsychological Associates, P.a. 7800 Metro Pkwy Suite 300 Bloomington MN 55425-1514 Ph: (952) 876-0727 |
| NPI Number | 1679633093 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 03/12/2009 |
| Medicare PECOS PAC ID | 1254355001 |
|---|---|
| Medicare Enrollment ID | O20060119000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679633093 | NPI | - | NPPES |
| 460980800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Thomas M Misukanis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922168244 PECOS PAC ID: 8426072273 Enrollment ID: I20060120000218 |
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