Healthcare Provider Details

I. General information

NPI: 1669182887
Provider Name (Legal Business Name): CHAM CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 07/30/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 HILLWIND RD. STE 100A
FRIDLEY MN
55432-5963
US

IV. Provider business mailing address

941 HILLWIND RD. STE 100A
FRIDLEY MN
55432-5963
US

V. Phone/Fax

Practice location:
  • Phone: 763-657-0569
  • Fax: 763-762-6574
Mailing address:
  • Phone: 763-657-0569
  • Fax: 763-762-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: INAS R MUHIDINE
Title or Position: FNP, OWNER
Credential: FNP
Phone: 763-657-0569