Healthcare Provider Details

I. General information

NPI: 1437132578
Provider Name (Legal Business Name): PAUL R REMARK LCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N 8TH AVE E
DULUTH MN
55805-2024
US

IV. Provider business mailing address

4855 WEST ARROWHEAD ROAD ESSENTIA HEALTH HERMANTOWN CLINIC
HERMANTOWN MN
55811-3936
US

V. Phone/Fax

Practice location:
  • Phone: 218-723-1112
  • Fax: 218-529-9120
Mailing address:
  • Phone: 218-786-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0247
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: