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General NPI Number Information
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NPI Number | 1215344742
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Entity Type | Organization
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Legal Business Name | MY MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1560 BEAM AVE
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1191
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Country | US
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Telephone | 651-484-6923
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Fax |
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Provider Business Mailing Address
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Address Line | 4872 STEEPLECHASE WAY
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City | EAGAN
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State | MN
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Zip | 55122-2978
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Country | US
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Telephone | 651-484-6923
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Fax |
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Authorized Official
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Title or Position | CMD/FOUNDER AND OWNER
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Name | CHAITANYA ANAND
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Credential | MD
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Telephone | 651-484-6923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 45908
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License Number State | MN
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