| NPI | 1316344153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY C DOBOS Credentialing Mananger 320-352-8475 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 208D00000X General Practice | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2020-04-13 |