Healthcare Provider Details

I. General information

NPI: 1376387134
Provider Name (Legal Business Name): ACCENTCARE MEDICAL GROUP OF MINNESOTA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 EUSTIS ST ST 150
SAINT PAUL MN
55114-0018
US

IV. Provider business mailing address

6400 SHAFER CT STE 300A
ROSEMONT IL
60018-4914
US

V. Phone/Fax

Practice location:
  • Phone: 612-728-2455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE BILL
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 847-644-2920