Healthcare Provider Details

I. General information

NPI: 1821266529
Provider Name (Legal Business Name): PROREADS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 VERNON AVE S SUITE 300
EDINA MN
55436
US

IV. Provider business mailing address

5021 VERNON AVE S SUITE 300
EDINA MN
55436
US

V. Phone/Fax

Practice location:
  • Phone: 612-280-9096
  • Fax:
Mailing address:
  • Phone: 612-280-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number20214283
License Number StateMN

VIII. Authorized Official

Name: MRS. MICHELLE KIM APPLENE
Title or Position: CEO
Credential:
Phone: 612-280-9096