Healthcare Provider Details

I. General information

NPI: 1447711015
Provider Name (Legal Business Name): MEDICAL CONSULTANTS CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LAKE ROAD AVE STE 301
ROBBINSDALE MN
55422-1845
US

IV. Provider business mailing address

4600 LAKE ROAD AVE STE 301
ROBBINSDALE MN
55422-1845
US

V. Phone/Fax

Practice location:
  • Phone: 763-588-7099
  • Fax: 763-522-2222
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER TRESNAK
Title or Position: OFFICE MANAGER
Credential:
Phone: 763-588-7099