MEDICARE: FAMILY HEALTHSERVICES MINNESOTA, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician
2	207Q00000X	Family Medicine Physician	1428	MN

General Provider Information

NPI Number	:	1124206677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTHSERVICES MINNESOTA, P.A.

Provider Business Mailing Address
First Line	:	2025 SLOAN PL STE 35
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2092
Country	:	US
Telephone Number	:	651-772-1572
Fax Number	:	651-772-1889

Provider Business Practice Location Address
First Line	:	2025 SLOAN PL
Second Line	:	SUITE 35
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2007
Country	:	US
Telephone Number	:	651-772-1572
Fax Number	:	651-772-1889

Authorized Official
Title or Position	:	CAO
Name	:	KEN PALATTAO
Credential	:
Telephone Number	:	651-772-1572

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	10/14/2025

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