Provider Demographics
NPI:1184841462
Name:MINNHEALTH FAMILY PHYSICIANS, P.A.
Entity Type:Organization
Organization Name:MINNHEALTH FAMILY PHYSICIANS, P.A.
Other - Org Name:MINNHEALTH - AFTON ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF MINNHEALTH
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:OELSCHLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-766-0520
Mailing Address - Street 1:2025 SLOAN PL
Mailing Address - Street 2:SUITE 35
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2007
Mailing Address - Country:US
Mailing Address - Phone:651-772-2262
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:2716 UPPER AFTON RD E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55119-4780
Practice Address - Country:US
Practice Address - Phone:651-739-5050
Practice Address - Fax:651-739-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01253Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER