Provider Demographics
NPI:1417193210
Name:MINNESOTA NATURAL MEDICINE
Entity Type:Organization
Organization Name:MINNESOTA NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-484-5567
Mailing Address - Street 1:3640 TALMAGE CIRCLE
Mailing Address - Street 2:#208
Mailing Address - City:VADNAIS HTS
Mailing Address - State:MN
Mailing Address - Zip Code:55110
Mailing Address - Country:US
Mailing Address - Phone:651-484-5567
Mailing Address - Fax:651-484-5011
Practice Address - Street 1:3640 TALMAGE CIRCLE
Practice Address - Street 2:#208
Practice Address - City:VADNAIS HTS
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-484-5567
Practice Address - Fax:651-484-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty