Healthcare Provider Details

I. General information

NPI: 1780238972
Provider Name (Legal Business Name): INTERNATIONAL MEDICINAL CENTERS OF MINNESOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S 6TH ST STE 2350
MINNEAPOLIS MN
55402-1829
US

IV. Provider business mailing address

PO BOX 50008
MINNEAPOLIS MN
55405-0008
US

V. Phone/Fax

Practice location:
  • Phone: 612-756-7615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SHERIF SAAD
Title or Position: CEO
Credential:
Phone: 612-787-5510