MEDICARE: TUBMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	8004872MHC	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376655159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUBMAN

Provider Business Mailing Address
First Line	:	4432 CHICAGO AVENUE SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-870-2444
Fax Number	:	612-870-2428

Provider Business Practice Location Address
First Line	:	4432 CHICAGO AVENUE SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-870-2444
Fax Number	:	612-870-2428

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BEVERLY DUSSO
Credential	:
Telephone Number	:	612-767-6690

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/04/2008

Similar Medicare Providers

1194696773 — HEIDI D NELSON
Practice Location Address:

800 E 28TH ST
MINNEAPOLIS, MN
55407-3723

Practice Phone: 612-863-6029
Practice Fax:

1437498466 — ELIZABETH ANN SCHAFER PA-C
Practice Location Address:

800 E 28TH ST , STE 401
MINNEAPOLIS, MN
55407-3723

Practice Phone: 612-863-0200
Practice Fax:

1518653963 — NATHAN HOLTHAUS
Practice Location Address:

2800 CHICAGO AVE STE 250
MINNEAPOLIS, MN
55407-1355

Practice Phone: 612-863-4000
Practice Fax:

1558109090 — NICHALAS ROLPH
Practice Location Address:

800 E 28TH ST
MINNEAPOLIS, MN
55407-3723

Practice Phone: 612-262-8425
Practice Fax:

1326992553 — IKRAN ALI SAID
Practice Location Address:

2750 PARK AVE
MINNEAPOLIS, MN
55407-1009

Practice Phone: 612-814-1119
Practice Fax:

1467398453 — ALLINA HEALTH SYSTEM
Practice Location Address:

2925 CHICAGO AVE
MINNEAPOLIS, MN
55407-1321

Practice Phone: 651-241-9700
Practice Fax: 651-241-9683

1780983569 — ROBERT DAVID VICHICH M.D.
Practice Location Address:

2925 CHICAGO AVE
MINNEAPOLIS, MN
55407-1321

Practice Phone: 651-241-9700
Practice Fax:

Directions to “TUBMAN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.