| Edina Sports And Family Medicine | |
|
7701 York Ave S Ste 300 Edina MN 55435-5864 | |
| (952) 926-6489 | |
| (952) 926-6501 |
| Full Name | Edina Sports And Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 7701 York Ave S Ste 300, Edina, Minnesota |
| Authorized Official Name and Position | Rochelle R. Taube (OWNER) |
| Authorized Official Contact | 9529266489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edina Sports And Family Medicine 7701 York Ave S Ste 300 Edina MN 55435-5864 Ph: (952) 926-6489 | Edina Sports And Family Medicine 7701 York Ave S Ste 300 Edina MN 55435-5864 Ph: (952) 926-6489 |
| NPI Number | 1215010335 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 01/24/2022 |
| Medicare PECOS PAC ID | 7012817596 |
|---|---|
| Medicare Enrollment ID | O20040112000058 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215010335 | NPI | - | NPPES |
| 550095800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 37465 (Minnesota) | Primary |
| Provider Name | Suzanne K Davidowitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366415127 PECOS PAC ID: 8022065614 Enrollment ID: I20050406000094 |
| Provider Name | Staci R Moser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013093004 PECOS PAC ID: 5698706471 Enrollment ID: I20050823000028 |
| Provider Name | Kristin C Haugan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548235443 PECOS PAC ID: 2769547256 Enrollment ID: I20090217000415 |
| Provider Name | Rochelle R Taube |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891995338 PECOS PAC ID: 2567361173 Enrollment ID: I20100602000828 |
| Provider Name | Nathan Gb Waibel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225354947 PECOS PAC ID: 3971774423 Enrollment ID: I20110914000389 |
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