Provider Demographics
NPI:1457417933
Name:MIDWEST IMMUNOLOGY CLINICS, PLLC
Entity Type:Organization
Organization Name:MIDWEST IMMUNOLOGY CLINICS, PLLC
Other - Org Name:INFUSION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-577-0008
Mailing Address - Street 1:21897 S DIAMOND LAKE RD
Mailing Address - Street 2:SUITE 400-307
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4642
Mailing Address - Country:US
Mailing Address - Phone:763-515-3993
Mailing Address - Fax:763-497-9248
Practice Address - Street 1:15700 37TH AVE N
Practice Address - Street 2:SUITE 110
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3399
Practice Address - Country:US
Practice Address - Phone:763-577-0008
Practice Address - Fax:763-577-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN454847700Medicaid
MN51B54MIOtherBLUE CROSS BLUE SHIELD
MN454847700Medicaid
MN51B54MIOtherBLUE CROSS BLUE SHIELD