Healthcare Provider Details

I. General information

NPI: 1336058064
Provider Name (Legal Business Name): PRIMECARE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8449 ALDRICH AVE S
BLOOMINGTON MN
55420-2214
US

IV. Provider business mailing address

8449 ALDRICH AVE S
BLOOMINGTON MN
55420-2214
US

V. Phone/Fax

Practice location:
  • Phone: 661-717-7224
  • Fax:
Mailing address:
  • Phone: 661-717-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FARDOWS O SALIM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 661-717-7224