| NPI | 1598325151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA J FEDERLY Owner/Physician 952-546-6866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2020-07-30 |