Provider Demographics
NPI:1790033249
Name:PARK AVENUE FAMILY PRACTICE
Entity Type:Organization
Organization Name:PARK AVENUE FAMILY PRACTICE
Other - Org Name:ARCADE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUNHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-771-5388
Mailing Address - Street 1:651 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4518
Mailing Address - Country:US
Mailing Address - Phone:651-771-5388
Mailing Address - Fax:
Practice Address - Street 1:651 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-4518
Practice Address - Country:US
Practice Address - Phone:651-771-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK AVENUE FAMILY PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center