Healthcare Provider Details

I. General information

NPI: 1518879477
Provider Name (Legal Business Name): NORTH STAR MPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 FRANCE AVE S STE 301
EDINA MN
55435-4505
US

IV. Provider business mailing address

7300 FRANCE AVE S STE 301
EDINA MN
55435-4505
US

V. Phone/Fax

Practice location:
  • Phone: 661-703-3935
  • Fax:
Mailing address:
  • Phone: 661-703-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY LOUIS ROACH
Title or Position: OWNER
Credential: MD
Phone: 661-703-3935