Healthcare Provider Details

I. General information

NPI: 1548575434
Provider Name (Legal Business Name): SYNERGY FAMILY PHYSICIANS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 WHITE BEAR AVE N
WHITE BEAR LAKE MN
55110-3475
US

IV. Provider business mailing address

4422 WHITE BEAR AVE N
WHITE BEAR LAKE MN
55110-3475
US

V. Phone/Fax

Practice location:
  • Phone: 651-287-8780
  • Fax: 651-287-8786
Mailing address:
  • Phone: 651-287-8780
  • Fax: 651-287-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER A CARPENTER
Title or Position: OWNER / PRESIDENT
Credential: M.D.
Phone: 651-287-8780