Provider Demographics
NPI:1356671267
Name:METRO VEIN CLINIC, PA
Entity Type:Organization
Organization Name:METRO VEIN CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:612-789-8346
Mailing Address - Street 1:3001 HARBOR LN N
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5102
Mailing Address - Country:US
Mailing Address - Phone:612-789-8346
Mailing Address - Fax:612-432-2464
Practice Address - Street 1:7362 UNIVERSITY AVE NE
Practice Address - Street 2:STE 201
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3142
Practice Address - Country:US
Practice Address - Phone:612-789-8346
Practice Address - Fax:763-432-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty