Healthcare Provider Details

I. General information

NPI: 1497489645
Provider Name (Legal Business Name): HI-GATE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 26TH AVE. S
MINNEAPOLIS MN
55406
US

IV. Provider business mailing address

2911 26TH AVE S
MINNEAPOLIS MN
55406-1555
US

V. Phone/Fax

Practice location:
  • Phone: 612-886-3626
  • Fax:
Mailing address:
  • Phone: 612-886-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADNO A GATAH
Title or Position: PNP / OWNER
Credential:
Phone: 612-866-3626