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General NPI Number Information
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NPI Number | 1639799323
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Entity Type | Organization
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Legal Business Name | NORTHERN CARDIOVASCULAR CLINIC, PA
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 6565 FRANCE AVE S STE 101
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City | EDINA
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State | MN
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Zip | 55435-2154
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Country | US
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Telephone | 952-500-0653
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Fax | 952-892-0254
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Provider Business Mailing Address
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Address Line | 6565 FRANCE AVE S STE 101
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City | EDINA
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State | MN
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Zip | 55435-2154
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Country | US
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Telephone | 952-500-0653
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Fax | 952-892-0254
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOMINIC A PLUCINSKI
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Credential | MD
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Telephone | 763-229-4006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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