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7920 Old Cedar Ave S Bloomington MN 55425-1207 | |
| (952) 428-1800 | |
| (952) 428-1723 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 7920 Old Cedar Ave S, Bloomington, Minnesota |
| Authorized Official Name and Position | Dominica Tallarico (COO) |
| Authorized Official Contact | 6122222222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 43 Mail Route 10585 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 7920 Old Cedar Ave S Bloomington MN 55425-1207 Ph: (952) 428-1800 |
| NPI Number | 1013213891 |
|---|---|
| Provider Enumeration Date | 01/27/2011 |
| Last Update Date | 01/14/2025 |
| Medicare PECOS PAC ID | 4587573613 |
|---|---|
| Medicare Enrollment ID | O20120315000348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013213891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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