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General NPI Number Information
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NPI Number | 1174989560
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Entity Type | Organization
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Legal Business Name | NORTHERN VEINS, P.A.
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 6565 FRANCE AVE S SUITE 101
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City | EDINA
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State | MN
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Zip | 55435-2137
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Country | US
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Telephone | 651-842-3375
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Fax |
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Provider Business Mailing Address
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Address Line | 2854 HIGHWAY 55 SUITE 130
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City | EAGAN
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State | MN
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Zip | 55121-2156
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Country | US
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Telephone | 651-224-4930
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMINIC A PLUCINSKI
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Credential | MD
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Telephone | 651-842-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | MN
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