Healthcare Provider Details

I. General information

NPI: 1124493721
Provider Name (Legal Business Name): ITEAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10259 LEE DR
EDEN PRAIRIE MN
55347-4809
US

IV. Provider business mailing address

10259 LEE DR
EDEN PRAIRIE MN
55347-4809
US

V. Phone/Fax

Practice location:
  • Phone: 952-297-2050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberITEAM
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMATAR FARAH
Title or Position: OWNER
Credential:
Phone: 952-297-2050