Healthcare Provider Details

I. General information

NPI: 1902115488
Provider Name (Legal Business Name): NEXTDOOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SHINGLE CREEK PKWY
MINNEAPOLIS MN
55430-2128
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 763-549-3540
  • Fax: 612-805-5510
Mailing address:
  • Phone: 702-560-2886
  • Fax: 702-560-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: KENNETH S EHLERT
Title or Position: CEO PRESIDENT
Credential:
Phone: 763-549-3540