Provider Demographics
NPI:1043236896
Name:MINNESOTA SPINE REHAB, INC
Entity Type:Organization
Organization Name:MINNESOTA SPINE REHAB, INC
Other - Org Name:SPECIALISTS IN OCCUPATIONAL & ENVRIONMENTAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIEF
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:651-209-6520
Mailing Address - Street 1:360 SHERMAN ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2564
Mailing Address - Country:US
Mailing Address - Phone:651-209-6520
Mailing Address - Fax:651-209-6521
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 470
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-209-6520
Practice Address - Fax:651-209-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33701261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM47D55MIOtherBCBS OF MN CLINIC NUMBER
FM79737OtherHEALTH PARTNERS GROUP NUM
FM9800099OtherMEDICA GROUP NUMBER
MNA001OtherTRICARE GROUP NUMBER
306COtherCHOICE PLUS GROUP NUMBER
MNF703OtherUCARE GROUP NUMBER
MN509491027972OtherPREFERRED ONE GROUP NUMBE
FM9800099OtherMEDICA GROUP NUMBER
306COtherCHOICE PLUS GROUP NUMBER