Provider Demographics
NPI:1609969484
Name:MINNEAPOLIS MEDICAL GROUP PC
Entity Type:Organization
Organization Name:MINNEAPOLIS MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-598-8880
Mailing Address - Street 1:1730 NEW BRIGHTON BLVD
Mailing Address - Street 2:#230
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1248
Mailing Address - Country:US
Mailing Address - Phone:952-746-1050
Mailing Address - Fax:952-746-1053
Practice Address - Street 1:7450 FRANCE AVE S
Practice Address - Street 2:SUITE 250
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-4787
Practice Address - Country:US
Practice Address - Phone:952-746-1050
Practice Address - Fax:952-746-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherEIN