Park Nicollet | |
9555 Upland Ln N Maple Grove MN 66369 | |
(952) 993-1589 | |
Not Available |
Full Name | Park Nicollet |
---|---|
Speciality | Clinic/center |
Location | 9555 Upland Ln N, Maple Grove, Minnesota |
Authorized Official Name and Position | Sofiya Tsukerman (HTCP) |
Authorized Official Contact | 7634944686 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Park Nicollet 7102 Olive Lane North Maple Grove MN 55311 Ph: () - | Park Nicollet 9555 Upland Ln N Maple Grove MN 66369 Ph: (952) 993-1589 |
NPI Number | 1982150728 |
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Provider Enumeration Date | 08/31/2016 |
Last Update Date | 08/31/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982150728 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | L 48617-4 (Minnesota) | Primary |
261QA1903X | Clinic/center - Ambulatory Surgical | L 48617-4 (Minnesota) | Secondary |
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