| |
500 Osborne Rd Ne Ste 150 Fridley MN 55432-2770 | |
(763) 786-6011 | |
(763) 236-2505 |
Full Name | |
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Speciality | Family Medicine |
Location | 500 Osborne Rd Ne Ste 150, Fridley, Minnesota |
Authorized Official Name and Position | Dominica Tallarico (COO) |
Authorized Official Contact | 6122222222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 43 Mail Route 10860 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 500 Osborne Rd Ne Ste 150 Fridley MN 55432-2770 Ph: (763) 786-6011 |
NPI Number | 1912203365 |
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Provider Enumeration Date | 02/02/2011 |
Last Update Date | 03/25/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912203365 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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