| Fridley Target Clinic | |
|
755 53rd Ave Ne Fridley MN 55421-1240 | |
| (763) 571-9361 | |
| Not Available |
| Full Name | Fridley Target Clinic |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 755 53rd Ave Ne, Fridley, Minnesota |
| Authorized Official Name and Position | Millicent Wanjohi (PHYSICIAN ASSISTANT) |
| Authorized Official Contact | 7635719361 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fridley Target Clinic 12375 Oak Park Blvd Ne Apt # 206 Blaine MN 55434-7302 Ph: (763) 862-9656 | Fridley Target Clinic 755 53rd Ave Ne Fridley MN 55421-1240 Ph: (763) 571-9361 |
| NPI Number | 1457437907 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457437907 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 935 (Minnesota) | Primary |
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