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General NPI Number Information
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NPI Number | 1518979285
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Entity Type | Organization
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Legal Business Name | KASS CLINICS, LLC
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 7104 W LAKE ST SUITE 100
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-4417
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Country | US
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Telephone | 952-926-3311
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Fax | 952-922-4492
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Provider Business Mailing Address
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Address Line | 2721 GLENHURST AVE
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-3909
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Country | US
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Telephone | 952-926-3311
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Fax | 952-922-4492
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Authorized Official
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Title or Position | OWNER
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Name | DR. SIDNEY W KASS
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Credential | MD
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Telephone | 952-926-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 33397
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License Number State | MN
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