Healthcare Provider Details

I. General information

NPI: 1124486097
Provider Name (Legal Business Name): KARIN FILIP PAC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 BLUEBIRD ST NW
ANDOVER MN
55304-3538
US

IV. Provider business mailing address

21395 JOHN MILLESS DR STE 100
ROGERS MN
55374-4404
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-4688
  • Fax:
Mailing address:
  • Phone: 763-504-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11993
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: