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NPI Code Detail

MEDICARE: SIP BROTHERS INC.

MEDICARE: SIP BROTHERS INC.
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
1261QA0600XAdult Day Care Clinic/Center

General Provider Information

NPI Number : 1568013191
Entity Type Code : Organization
Provider Name (Legal Business Name) : SIP BROTHERS INC.
Provider Business Mailing Address
First Line : 4618 85TH AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1957
Country : US
Telephone Number : 612-245-9177
Fax Number :
Provider Business Practice Location Address
First Line : 4618 85TH AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1957
Country : US
Telephone Number : 612-245-9177
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CALVIN SIPHAPASERTH
Credential :
Telephone Number : 612-245-9177
Provider Enumeration Date : 09/25/2019
Last Update Date : 09/25/2019

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Directions to “SIP BROTHERS INC. ” Practice Location

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