Provider Demographics
NPI:1265003420
Name:ISUROON SPECIALTY CARE CLINIC
Entity Type:Organization
Organization Name:ISUROON SPECIALTY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARTUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-866-2731
Mailing Address - Street 1:1600 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1846
Mailing Address - Country:US
Mailing Address - Phone:612-866-2731
Mailing Address - Fax:
Practice Address - Street 1:1600 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1846
Practice Address - Country:US
Practice Address - Phone:612-866-2731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISUROON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health