| Mina Medical Clinic Llc | |
|
1690 Silver Lake Road Nw New Brighton MN 55112 | |
| (612) 274-4380 | |
| Not Available |
| Full Name | Mina Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1690 Silver Lake Road Nw, New Brighton, Minnesota |
| Authorized Official Name and Position | Idiris Esse (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6122744380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mina Medical Clinic Llc 6417 Penn Ave S Ste 8 Minneapolis MN 55423-1196 Ph: (612) 274-4380 | Mina Medical Clinic Llc 1690 Silver Lake Road Nw New Brighton MN 55112 Ph: (612) 274-4380 |
| NPI Number | 1457088809 |
|---|---|
| Provider Enumeration Date | 08/05/2022 |
| Last Update Date | 08/05/2022 |
| Medicare PECOS PAC ID | 4587040001 |
|---|---|
| Medicare Enrollment ID | O20221005003681 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457088809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Idiris Abdirahman Esse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457813420 PECOS PAC ID: 8628458932 Enrollment ID: I20221005003716 |
| Provider Name | Sadiya Abdirahman Esse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619587193 PECOS PAC ID: 8527434679 Enrollment ID: I20221014002219 |
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