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General NPI Number Information
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NPI Number | 1255272043
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Entity Type | Organization
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Legal Business Name | MIRACULIN LLC
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 10449 172ND LN NW
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City | ELK RIVER
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State | MN
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Zip | 55330-4314
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Country | US
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Telephone | 612-475-8894
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Fax | 612-475-8894
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Provider Business Mailing Address
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Address Line | 10449 172ND LN NW
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City | ELK RIVER
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State | MN
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Zip | 55330-4314
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Country | US
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Telephone | 612-475-8894
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Fax | 612-475-8894
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Authorized Official
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Title or Position | DIRECTOR
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Name | ABIODUN OLUFEMI JEGEDE
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Credential | JEGEDE
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Telephone | 320-380-4283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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