| Southdale Medical Partners Corporation | |
|
902 Inwood Ave N Ste 902 Oakdale MN 55128-6625 | |
| (952) 999-4049 | |
| Not Available |
| Full Name | Southdale Medical Partners Corporation |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 902 Inwood Ave N Ste 902, Oakdale, Minnesota |
| Authorized Official Name and Position | Mitchell Paul Brandt (ADMINISTRATOR) |
| Authorized Official Contact | 6129614322 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southdale Medical Partners Corporation 902 Inwood Ave N Saint Paul MN 55128-6625 Ph: (651) 815-6880 | Southdale Medical Partners Corporation 902 Inwood Ave N Ste 902 Oakdale MN 55128-6625 Ph: (952) 999-4049 |
| NPI Number | 1043898778 |
|---|---|
| Provider Enumeration Date | 04/01/2021 |
| Last Update Date | 05/03/2023 |
| Medicare PECOS PAC ID | 9931506359 |
|---|---|
| Medicare Enrollment ID | O20210927002724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043898778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Karyn Brinker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356939383 PECOS PAC ID: 5698183960 Enrollment ID: I20210427000440 |
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