| NPI | 1649582669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN L COULTER President / Medical Director 612-276-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 122300000X Dentist |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2011-02-01 |