Provider Demographics
NPI:1467969907
Name:MINNEAPOLIS HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:MINNEAPOLIS HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:A B
Authorized Official - Last Name:TOTOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-876-5703
Mailing Address - Street 1:4825 OLSON MEMORIAL HWY.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-496-5708
Mailing Address - Fax:888-507-5033
Practice Address - Street 1:4825 OLSON MEMORIAL HWY.
Practice Address - Street 2:SUITE 101
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-496-5708
Practice Address - Fax:888-507-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty