Provider Demographics
NPI:1720315567
Name:CITIES LUNG CLINIC PA
Entity Type:Organization
Organization Name:CITIES LUNG CLINIC PA
Other - Org Name:CITIES LUNG CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:GRAIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:736-398-0740
Mailing Address - Street 1:500 OSBORNE RD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2783
Mailing Address - Country:US
Mailing Address - Phone:763-398-0740
Mailing Address - Fax:763-398-0742
Practice Address - Street 1:500 OSBORNE RD NE
Practice Address - Street 2:SUITE 360
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2783
Practice Address - Country:US
Practice Address - Phone:763-398-0740
Practice Address - Fax:763-398-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26570207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty