Provider Demographics
NPI:1922129790
Name:MINNESOTA VEIN CENTER, P.A.
Entity Type:Organization
Organization Name:MINNESOTA VEIN CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIMEPARES
Authorized Official - Middle Name:GONO
Authorized Official - Last Name:PAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-765-8346
Mailing Address - Street 1:400 VILLAGE CENTER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7201
Mailing Address - Country:US
Mailing Address - Phone:651-765-8346
Mailing Address - Fax:651-765-8351
Practice Address - Street 1:400 VILLAGE CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7201
Practice Address - Country:US
Practice Address - Phone:651-765-8346
Practice Address - Fax:651-765-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1660261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO3964Medicare ID - Type Unspecified
MNF69104Medicare UPIN