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General NPI Number Information
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NPI Number | 1043236896
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Entity Type | Organization
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Legal Business Name | MINNESOTA SPINE REHAB, INC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 360 SHERMAN ST SUITE 470
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City | SAINT PAUL
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State | MN
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Zip | 55102-2564
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Country | US
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Telephone | 651-209-6520
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Fax | 651-209-6521
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Provider Business Mailing Address
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Address Line | 360 SHERMAN ST SUITE 470
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City | SAINT PAUL
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State | MN
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Zip | 55102-2564
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Country | US
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Telephone | 651-209-6520
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Fax | 651-209-6521
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SHERIEF A MIKHAIL
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Credential | M.D., M.P.H.
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Telephone | 651-209-6520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 33701
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License Number State | MN
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