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General NPI Number Information
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NPI Number | 1508711235
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Entity Type | Organization
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Legal Business Name | NORTHEAST CLINIC PLLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 3620 CENTRAL AVE NE STE 4
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-1377
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Country | US
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Telephone | 763-744-7960
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Fax | 952-242-9153
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Provider Business Mailing Address
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Address Line | 3620 CENTRAL AVE NE STE 4
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-1377
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Country | US
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Telephone | 763-744-7960
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Fax | 952-242-9153
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Authorized Official
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Title or Position | CEO
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Name | AMIN MOHAMMED YOUSUF
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Credential | PA-C
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Telephone | 763-744-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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