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General NPI Number Information
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NPI Number | 1871975607
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Entity Type | Organization
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Legal Business Name | MINNESOTA HEAD AND NECK PAIN CLINIC, PA
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 3475 PLYMOUTH BLVD SUITE 200
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City | PLYMOUTH
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State | MN
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Zip | 55447-1499
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Country | US
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Telephone | 763-577-2484
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Fax | 763-577-1375
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Provider Business Mailing Address
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Address Line | 3475 PLYMOUTH BLVD SUITE 200
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City | PLYMOUTH
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State | MN
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Zip | 55447-1499
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Country | US
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Telephone | 763-577-2484
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Fax | 763-577-1375
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Authorized Official
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Title or Position | CHRO/CLINIC ADMINISTRATOR
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Name | TIA A REICHERT
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Credential |
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Telephone | 763-577-2484
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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 |
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License Number State |
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