| NPI | 1790085140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA GRAIKOWSKI VP Medicare Product 952-931-5594 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2010-11-01 |