Healthcare Provider Details

I. General information

NPI: 1245343771
Provider Name (Legal Business Name): ARLENE BOUTIN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST 28TH ST
MINNEAPOLIS MN
55407
US

IV. Provider business mailing address

PO BOX 365
CIRCLE PINES MN
55014
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-4000
  • Fax:
Mailing address:
  • Phone: 612-710-3671
  • Fax: 763-295-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE BATKIEWICZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-863-4000