Provider Demographics
NPI:1780771931
Name:PAMELA CAIN, M.D., LLC
Entity type:Organization
Organization Name:PAMELA CAIN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-938-6699
Mailing Address - Street 1:6490 EXCELSIOR BLVD STE W106
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4741
Mailing Address - Country:US
Mailing Address - Phone:952-938-6699
Mailing Address - Fax:952-938-1906
Practice Address - Street 1:6490 EXCELSIOR BLVD STE W106
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4741
Practice Address - Country:US
Practice Address - Phone:952-938-6699
Practice Address - Fax:952-938-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN132304OtherUCARE
MNHP10204OtherHEALTH PARTNERS
MN0407565OtherMEDICA
MN296G3CAOtherBLUE CROSS OF MN
MN296G3CAOtherBLUE CROSS OF MN