Healthcare Provider Details

I. General information

NPI: 1275528671
Provider Name (Legal Business Name): MULTICARE ASSOCIATES OF THE TWIN CITIES,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 OSBORNE RD NE SUITE 100
FRIDLEY MN
55432-2773
US

IV. Provider business mailing address

480 OSBORNE RD NE SUITE 100
FRIDLEY MN
55432-2773
US

V. Phone/Fax

Practice location:
  • Phone: 763-785-4500
  • Fax: 763-785-3314
Mailing address:
  • Phone: 763-785-4500
  • Fax: 763-785-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35
License Number StateMN

VIII. Authorized Official

Name: MR. CARL MATTHEW BRANDT
Title or Position: CEO
Credential:
Phone: 763-785-7710