MEDICARE: CHINA INSTITUTE OF TRADITIONAL CHINESE MEDICINE

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	302R00000X	Health Maintenance Organization	1072	MN

General Provider Information

NPI Number	:	1528237005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINA INSTITUTE OF TRADITIONAL CHINESE MEDICINE

Provider Business Mailing Address
First Line	:	1033 GRAND AVENUE
Second Line	:
City	:	ST PAUL
State	:	MN
Zip	:	55105
Country	:	US
Telephone Number	:	651-222-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3019
Country	:	US
Telephone Number	:	651-222-1200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ZHUOLING REN
Credential	:
Telephone Number	:	651-222-1200

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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