NPI | 1194437061 |
---|---|
Entity Type | Organization |
Authorized Contact | ROBERT LARBI-ODAM Medical Director 952-228-0420 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
207RR0500X Internal Medicine, Rheumatology | |
207V00000X Obstetrics & Gynecology | |
208000000X Pediatrics | |
2084P0800X Psychiatry & Neurology, Psychiatry | |
207K00000X Allergy & Immunology | |
207Q00000X Family Medicine | |
207R00000X Internal Medicine | |
Enumeration Date | 2022-12-21 |
Last Update Date | 2023-03-31 |