Healthcare Provider Details

I. General information

NPI: 1780828806
Provider Name (Legal Business Name): CORNER MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 HUMBOLDT AVE S
BLOOMINGTON MN
55431-2623
US

IV. Provider business mailing address

2730 NEVADA AVE N
NEW HOPE MN
55427-2807
US

V. Phone/Fax

Practice location:
  • Phone: 952-388-0500
  • Fax: 952-388-0444
Mailing address:
  • Phone: 763-535-5335
  • Fax: 952-388-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number361419
License Number StateMN

VIII. Authorized Official

Name: MR. DAN STEINHAUSER
Title or Position: PRESIDENT
Credential:
Phone: 763-535-5335