Healthcare Provider Details

I. General information

NPI: 1437305299
Provider Name (Legal Business Name): ALLINA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 PRAIRIE CENTER DR STE 300
EDEN PRAIRIE MN
55344-7317
US

IV. Provider business mailing address

2925 CHICAGO AVE MR 10585
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-0300
  • Fax:
Mailing address:
  • Phone: 612-262-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOMINICA TALLARICO
Title or Position: COO
Credential:
Phone: 612-222-2222