Healthcare Provider Details

I. General information

NPI: 1093992810
Provider Name (Legal Business Name): CROWN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 78TH AVE N
BROOKLYN PARK MN
55445-2783
US

IV. Provider business mailing address

7001 78TH AVE N
BROOKLYN PARK MN
55445-2783
US

V. Phone/Fax

Practice location:
  • Phone: 763-566-4535
  • Fax:
Mailing address:
  • Phone: 763-566-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number36657
License Number StateMN

VIII. Authorized Official

Name: DR. JOYCE IHIOMA ONYEKABA
Title or Position: DIRECTOR
Credential: MD
Phone: 763-566-4535