Provider Demographics
NPI:1659464162
Name:REALIEF MEDICAL, P.A.
Entity Type:Organization
Organization Name:REALIEF MEDICAL, P.A.
Other - Org Name:REALIEF MEDICAL, P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DC
Authorized Official - Phone:952-456-6160
Mailing Address - Street 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:SUITE 229
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:952-456-6160
Mailing Address - Fax:952-835-9830
Practice Address - Street 1:1660 HIGHWAY 100 S
Practice Address - Street 2:SUITE 229
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1529
Practice Address - Country:US
Practice Address - Phone:952-456-6160
Practice Address - Fax:952-835-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24538208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1396838850OtherNPI
1508102500OtherGROUP NPI
C09271OtherGROUP MEDICARE NUMBER