Provider Demographics
NPI:1639799323
Name:NORTHERN CARDIOVASCULAR CLINIC, PA
Entity Type:Organization
Organization Name:NORTHERN CARDIOVASCULAR CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLUCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-229-4006
Mailing Address - Street 1:6565 FRANCE AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2154
Mailing Address - Country:US
Mailing Address - Phone:952-500-0653
Mailing Address - Fax:952-892-0254
Practice Address - Street 1:6565 FRANCE AVE S STE 101
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2154
Practice Address - Country:US
Practice Address - Phone:952-500-0653
Practice Address - Fax:952-892-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center