Provider Demographics
NPI:1164548590
Name:PLATINUM HEALTH, LLC
Entity Type:Organization
Organization Name:PLATINUM HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:YAKSHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-383-7818
Mailing Address - Street 1:3225 ROSEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2712
Mailing Address - Country:US
Mailing Address - Phone:763-383-7818
Mailing Address - Fax:763-553-9340
Practice Address - Street 1:9825 HOSPITAL DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-383-7818
Practice Address - Fax:763-553-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN034111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE57325Medicare UPIN