Provider Demographics
NPI:1982802773
Name:TWIN CITIES MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:TWIN CITIES MEDICAL CLINIC PC
Other - Org Name:FASTCARE OF TCMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAES ERIK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OLDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-229-1171
Mailing Address - Street 1:2701 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4271
Mailing Address - Country:US
Mailing Address - Phone:612-229-1171
Mailing Address - Fax:612-836-0626
Practice Address - Street 1:4601 EXCELSIOR BLVD STE 407
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4977
Practice Address - Country:US
Practice Address - Phone:952-926-0025
Practice Address - Fax:952-926-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3618OtherHEALTHPARTNERS
MN68944000Medicaid
MN407A8AMOtherBCBSMN
MN68944000Medicaid