| NPI | 1477869311 |
|---|---|
| Doing Business As | NORTHEAST PEDIATRIC CLINIC |
| Entity Type | Organization |
| Authorized Contact | JERRY L MASSMANN CFO 612-813-6113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MN 347125) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2022-10-31 |