Provider Demographics
NPI:1790709830
Name:ANOKA AREA FAMILY MEDICINE CLINIC, PA
Entity Type:Organization
Organization Name:ANOKA AREA FAMILY MEDICINE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LOES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-421-2273
Mailing Address - Street 1:14569 WACO ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6181
Mailing Address - Country:US
Mailing Address - Phone:763-421-7988
Mailing Address - Fax:763-421-2236
Practice Address - Street 1:3883 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2518
Practice Address - Country:US
Practice Address - Phone:763-421-2273
Practice Address - Fax:763-421-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B54645Medicare UPIN