Healthcare Provider Details

I. General information

NPI: 1235381476
Provider Name (Legal Business Name): HOMEOPATHIC MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 EXCELSIOR BLVD
MINNEAPOLIS MN
55416-4728
US

IV. Provider business mailing address

4201 EXCELSIOR BLVD
MINNEAPOLIS MN
55416-4728
US

V. Phone/Fax

Practice location:
  • Phone: 952-933-8900
  • Fax: 952-945-9536
Mailing address:
  • Phone: 952-933-8900
  • Fax: 952-945-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB I MIRMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 952-933-8900