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4786 Banning Ave White Bear Lake MN 55110-3264 | |
(651) 426-6402 | |
(651) 429-3402 |
Full Name | |
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Speciality | Family Medicine |
Location | 4786 Banning Ave, White Bear Lake, Minnesota |
Authorized Official Name and Position | Keith A Oelschlager (MINNHEATLH PRESIDENT) |
Authorized Official Contact | 6517660520 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2025 Sloan Pl Suite Saint Paul MN 55117-2007 Ph: (651) 772-2262 | 4786 Banning Ave White Bear Lake MN 55110-3264 Ph: (651) 426-6402 |
NPI Number | 1871710988 |
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Provider Enumeration Date | 04/19/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1871710988 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 1124 (Minnesota) | Primary |
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