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General NPI Number Information
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NPI Number | 1154416402
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Entity Type | Organization
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Legal Business Name | MID-MINNESOTA NEUROLOGY CLINIC, P.A.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 206 PINE ST
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City | MONTICELLO
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State | MN
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Zip | 55362-8665
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Country | US
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Telephone | 763-295-3844
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Fax |
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Provider Business Mailing Address
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Address Line | 13985 OAKWOOD CT NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-4514
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Country | US
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Telephone | 763-497-9906
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Fax | 763-497-9906
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. THANH K. DANG
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Credential | M.D.
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Telephone | 763-497-9906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 37961
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License Number State | MN
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