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General NPI Number Information
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NPI Number | 1962580274
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Entity Type | Organization
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Legal Business Name | THE CHILDRENS HEART CLINIC P,A
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 2530 CHICAGO AVE SUITE 500
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4291
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Country | US
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Telephone | 612-813-8800
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Fax | 612-813-8825
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Provider Business Mailing Address
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Address Line | 2530 CHICAGO AVE SUITE 500
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-4291
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Country | US
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Telephone | 612-813-8800
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Fax | 612-813-8825
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Authorized Official
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Title or Position | CLINIC OPERATIONS COORDINATOR
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Name | MRS. SOSSIA MILLER LAKE
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Credential |
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Telephone | 612-813-8801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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