Provider Demographics
NPI:1790804235
Name:ASSOCIATES IN NEWBORN MEDICINE, P.A.
Entity Type:Organization
Organization Name:ASSOCIATES IN NEWBORN MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-426-6995
Mailing Address - Street 1:4770 WHITE BEAR PKWY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3394
Mailing Address - Country:US
Mailing Address - Phone:651-426-6995
Mailing Address - Fax:651-426-6439
Practice Address - Street 1:347 SMITH AVE N
Practice Address - Street 2:SUITE 505
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2387
Practice Address - Country:US
Practice Address - Phone:651-220-6260
Practice Address - Fax:651-220-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03178Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER