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General NPI Number Information
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NPI Number | 1336058064
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Entity Type | Organization
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Legal Business Name | PRIMECARE PHYSICIANS
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/07/2026
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Provider Practice Location Address
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Address Line | 8449 ALDRICH AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2214
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Country | US
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Telephone | 661-717-7224
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Fax |
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Provider Business Mailing Address
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Address Line | 8449 ALDRICH AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2214
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Country | US
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Telephone | 661-717-7224
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | FARDOWS O SALIM
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Credential | MD
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Telephone | 661-717-7224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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