Healthcare Provider Details

I. General information

NPI: 1255300984
Provider Name (Legal Business Name): MINNESOTA PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 UNIVERSITY AVE W SUITE 122
SAINT PAUL MN
55103-2072
US

IV. Provider business mailing address

574 PRAIRIE CENTER DR #135-310
EDEN PRAIRIE MN
55344-7930
US

V. Phone/Fax

Practice location:
  • Phone: 651-731-0707
  • Fax: 651-739-1674
Mailing address:
  • Phone: 952-995-0151
  • Fax: 651-739-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number1345
License Number StateMN

VIII. Authorized Official

Name: MR. SAMUEL K YUE
Title or Position: PRESIDENT
Credential:
Phone: 651-731-0707