Provider Demographics
NPI:1295917995
Name:EXECUTIVE HEALTH CARE
Entity type:Organization
Organization Name:EXECUTIVE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:MCLINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-870-6268
Mailing Address - Street 1:920 E 28TH STREET
Mailing Address - Street 2:SUITE 740
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1163
Mailing Address - Country:US
Mailing Address - Phone:612-871-6268
Mailing Address - Fax:612-870-1666
Practice Address - Street 1:920 E 28TH STREET
Practice Address - Street 2:SUITE 740
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1163
Practice Address - Country:US
Practice Address - Phone:612-871-6268
Practice Address - Fax:612-870-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty