| NPI | 1700427499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINICA TALLARICO COO 612-222-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2025-02-25 |