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300 5th Ave Ne Isanti MN 55040-2205 | |
(763) 000-0000 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 300 5th Ave Ne, Isanti, 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 |
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Po Box 43 Mail Route 10585 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 300 5th Ave Ne Isanti MN 55040-2205 Ph: (763) 000-0000 |
NPI Number | 1205385325 |
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Provider Enumeration Date | 09/30/2016 |
Last Update Date | 01/16/2025 |
Medicare PECOS PAC ID | 4587573613 |
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Medicare Enrollment ID | O20180214001917 |
Identifier | Type | State | Issuer |
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1205385325 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |