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3131 19th Avenue South Room 122 Minneapolis MN 55409 | |
(612) 668-4333 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Student Health |
Location | 3131 19th Avenue South, Minneapolis, Minnesota |
Authorized Official Name and Position | Barbara Ann Kyle (SBC MANAGER) |
Authorized Official Contact | 6126735305 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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505 4th Ave S Rm 520 Minneapolis MN 55415-1345 Ph: (612) 673-2301 | 3131 19th Avenue South Room 122 Minneapolis MN 55409 Ph: (612) 668-4333 |
NPI Number | 1598817678 |
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Provider Enumeration Date | 01/17/2007 |
Last Update Date | 11/18/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598817678 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Secondary |
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
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