| Neuro Pllc | |
|
15600 36th Ave N Ste 140 Plymouth MN 55446-3372 | |
| (763) 308-5772 | |
| (612) 392-7974 |
| Full Name | Neuro Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 15600 36th Ave N Ste 140, Plymouth, Minnesota |
| Authorized Official Name and Position | Anthony Odland (OWNER/CEO) |
| Authorized Official Contact | 3204918233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuro Pllc 15600 36th Ave N Ste 140 Plymouth MN 55446-3372 Ph: (320) 491-8233 | Neuro Pllc 15600 36th Ave N Ste 140 Plymouth MN 55446-3372 Ph: (763) 308-5772 |
| NPI Number | 1003542069 |
|---|---|
| Provider Enumeration Date | 08/01/2022 |
| Last Update Date | 08/01/2022 |
| Certification Date | 07/31/2022 |
| Medicare PECOS PAC ID | 4587040902 |
|---|---|
| Medicare Enrollment ID | O20221007000867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003542069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Anthony P Odland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669853099 PECOS PAC ID: 8426363888 Enrollment ID: I20180612001217 |
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