Healthcare Provider Details

I. General information

NPI: 1710040456
Provider Name (Legal Business Name): REHABILITATION CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 BLUE GENTIAN RD SUITE 150
EAGAN MN
55121-1669
US

IV. Provider business mailing address

3006 FRANK ST
MAPLEWOOD MN
55109-5501
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-1600
  • Fax: 651-379-1650
Mailing address:
  • Phone: 651-699-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number45600
License Number StateMN

VIII. Authorized Official

Name: DR. ELENA LEV POLUKHIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 651-699-0633