Provider Demographics
NPI:1821815697
Name:GREATER MINNESOTA ALLERGY AND ASTHMA
Entity type:Organization
Organization Name:GREATER MINNESOTA ALLERGY AND ASTHMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINTO
Authorized Official - Middle Name:K
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-654-8266
Mailing Address - Street 1:1511 NORTHWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1262
Mailing Address - Country:US
Mailing Address - Phone:320-654-8266
Mailing Address - Fax:
Practice Address - Street 1:1511 NORTHWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1262
Practice Address - Country:US
Practice Address - Phone:320-654-8266
Practice Address - Fax:320-654-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty