=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366751562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINNESOTA INSTITUTE FOR PAIN MANAGEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2010
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2780 SNELLING AVE N STE 304
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55113-7125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-789-3141
-----------------------------------------------------
Fax | 651-888-2611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2780 SNELLING AVE N STE 304
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55113-7125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-789-3141
-----------------------------------------------------
Fax | 651-888-2611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/ OWNER
-----------------------------------------------------
Name | SANJEEV ARORA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 651-789-3141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 46656
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------