Provider Demographics
NPI:1518338268
Name:NORTHSTAR PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:NORTHSTAR PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-644-8835
Mailing Address - Street 1:924 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:924 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4987
Practice Address - Country:US
Practice Address - Phone:612-644-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1952207Q00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty