| |
15650 Cedar Ave Apple Valley MN 55124-7283 | |
(952) 997-4100 | |
(952) 997-4102 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 15650 Cedar Ave, Apple Valley, Minnesota |
Authorized Official Name and Position | Daniel M Fromm (CFO) |
Authorized Official Contact | 6126724976 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 9372 Minneapolis MN 55440-9372 Ph: (612) 672-6724 | 15650 Cedar Ave Apple Valley MN 55124-7283 Ph: (952) 997-4100 |
NPI Number | 1649462508 |
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Provider Enumeration Date | 08/15/2007 |
Last Update Date | 10/09/2012 |
Identifier | Type | State | Issuer |
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1649462508 | NPI | - | NPPES |
752820501 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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