Sharon R Koukkari Llc | |
5354 Parkdale Dr Suite 300 St Louis Pk MN 55416-1603 | |
(512) 889-1692 | |
(952) 546-1445 |
Full Name | Sharon R Koukkari Llc |
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Speciality | Community/behavioral Health |
Location | 5354 Parkdale Dr, St Louis Pk, Minnesota |
Authorized Official Name and Position | Sharon R Koukkari (PRESIDENT) |
Authorized Official Contact | 6128891692 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Sharon R Koukkari Llc 19320 81st Pl N Maple Grove MN 55311-1625 Ph: (612) 889-1692 | Sharon R Koukkari Llc 5354 Parkdale Dr Suite 300 St Louis Pk MN 55416-1603 Ph: (512) 889-1692 |
NPI Number | 1306170741 |
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Provider Enumeration Date | 10/01/2009 |
Last Update Date | 10/01/2009 |
Identifier | Type | State | Issuer |
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1306170741 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | LP1444 (Minnesota) | Primary |