| NPI | 1578121356 |
|---|---|
| Doing Business As | FAIRVIEW GRAND ITASCA CLINIC MTM |
| Entity Type | Organization |
| Authorized Contact | SAMEER BADLANI Chairman Of The Board 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-03-12 |