Provider Demographics
NPI:1710281647
Name:CONSULTATIVE HEALTH AND MEDICINE, PA
Entity Type:Organization
Organization Name:CONSULTATIVE HEALTH AND MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-868-0136
Mailing Address - Street 1:5520 RIDGEWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8239
Mailing Address - Country:US
Mailing Address - Phone:612-868-0136
Mailing Address - Fax:952-472-3837
Practice Address - Street 1:5520 RIDGEWOOD CV
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55364-8239
Practice Address - Country:US
Practice Address - Phone:612-868-0136
Practice Address - Fax:952-472-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty