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General NPI Number Information
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NPI Number | 1821758277
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Entity Type | Organization
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Legal Business Name | SPARK HEALTH, LLC
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 308 4TH AVE NW STE 4
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City | AUSTIN
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State | MN
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Zip | 55912-3085
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Country | US
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Telephone | 507-279-2345
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Fax | 833-340-7428
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Provider Business Mailing Address
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Address Line | 308 4TH AVE NW STE 4
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City | AUSTIN
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State | MN
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Zip | 55912-3085
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Country | US
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Telephone | 507-279-2345
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Fax | 833-340-7428
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Authorized Official
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Title or Position | PHYSICIAN, OWNDER
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Name | DR. DAVID WILLIAM STROBEL
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Credential | MD
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Telephone | 763-489-8979
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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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