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General NPI Number Information
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NPI Number | 1992739247
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Entity Type | Organization
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Legal Business Name | MINNEAPOLIS CLINIC OF NEUROLOGY, LTD
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 4225 GOLDEN VALLEY RD
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-4215
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Country | US
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Telephone | 763-588-0661
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Fax | 763-287-2310
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Provider Business Mailing Address
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Address Line | 4225 GOLDEN VALLEY RD
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-4215
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Country | US
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Telephone | 763-588-0661
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Fax | 763-287-2310
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES HAUGEN HOROWITZ
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Credential | M.D.
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Telephone | 763-302-4114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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