Healthcare Provider Details

I. General information

NPI: 1598465155
Provider Name (Legal Business Name): VITAE HEALTH MEDICAL MINNESOTA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 OLD HUDSON RD
SAINT PAUL MN
55119-4416
US

IV. Provider business mailing address

415 W GOLF RD STE 26
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 612-790-6427
  • Fax:
Mailing address:
  • Phone: 224-777-8045
  • Fax: 312-312-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. YITZCHAK FREUND
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 224-777-8045