Healthcare Provider Details

I. General information

NPI: 1689600033
Provider Name (Legal Business Name): PREVENTIVE CARDIOLOGY CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVENUE S. SUITE #125
EDINA MN
55435
US

IV. Provider business mailing address

7801 EAST BUSH LAKE RD. SUITE 320
BLOOMINGTON MN
55439
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-5600
  • Fax: 952-929-5610
Mailing address:
  • Phone: 952-831-5773
  • Fax: 952-831-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KLODAS
Title or Position: PROVIDER/OWNER
Credential: MD
Phone: 952-929-5600