| Portages Health Llc | |
|
310 4th Ave S Ste 5010 Minneapolis MN 55415-1053 | |
| (320) 492-2232 | |
| Not Available |
| Full Name | Portages Health Llc |
|---|---|
| Speciality | Psychologist |
| Location | 310 4th Ave S Ste 5010, Minneapolis, Minnesota |
| Authorized Official Name and Position | Leonard Read Sulik (SOLE MBR) |
| Authorized Official Contact | 3204922232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portages Health Llc 310 4th Ave S Ste 5010 Minneapolis MN 55415-1053 Ph: () - | Portages Health Llc 310 4th Ave S Ste 5010 Minneapolis MN 55415-1053 Ph: (320) 492-2232 |
| NPI Number | 1942945761 |
|---|---|
| Provider Enumeration Date | 05/05/2022 |
| Last Update Date | 05/05/2022 |
| Certification Date | 05/05/2022 |
| Medicare PECOS PAC ID | 6800269861 |
|---|---|
| Medicare Enrollment ID | O20230222002907 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942945761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | (* (Not Available)) | Primary |
| Provider Name | Leonard Sulik |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083664130 PECOS PAC ID: 6305829821 Enrollment ID: I20040608000044 |
| Provider Name | Michael Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669636858 PECOS PAC ID: 9335505734 Enrollment ID: I20230509002022 |
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