MEDICARE: HOMEOPATHIC MEDICAL CLINIC

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	261QH0100X	Health Service Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235381476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMEOPATHIC MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	4201 EXCELSIOR BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4728
Country	:	US
Telephone Number	:	952-933-8900
Fax Number	:	952-945-9536

Provider Business Practice Location Address
First Line	:	4201 EXCELSIOR BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4728
Country	:	US
Telephone Number	:	952-933-8900
Fax Number	:	952-945-9536

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACOB I MIRMAN
Credential	:	MD
Telephone Number	:	952-933-8900

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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Directions to “HOMEOPATHIC MEDICAL CLINIC ” Practice Location

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