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7240 Brooklyn Blvd Ste 200 Brooklyn Park MN 55429-1280 | |
| (612) 875-2733 | |
| (763) 428-8495 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 7240 Brooklyn Blvd Ste 200, Brooklyn Park, Minnesota |
| Authorized Official Name and Position | Russell Rooney (PARTNER) |
| Authorized Official Contact | 6128752733 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7240 Brooklyn Blvd Ste 200 Brooklyn Park MN 55429-1280 Ph: () - | 7240 Brooklyn Blvd Ste 200 Brooklyn Park MN 55429-1280 Ph: (612) 875-2733 |
| NPI Number | 1972906097 |
|---|---|
| Provider Enumeration Date | 10/02/2014 |
| Last Update Date | 01/06/2025 |
| Medicare PECOS PAC ID | 6709192651 |
|---|---|
| Medicare Enrollment ID | O20150909000017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972906097 | NPI | - | NPPES |
| Provider Name | Cornelia Dahm |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487729273 PECOS PAC ID: 5698776656 Enrollment ID: I20070118000387 |
| Provider Name | Teresa M Tawil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912973884 PECOS PAC ID: 0840335287 Enrollment ID: I20100309000938 |
| Provider Name | Thomas G Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316495401 PECOS PAC ID: 4284916727 Enrollment ID: I20170118002240 |
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