MEDICARE: NEW DIAGNOSIS LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1366112260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW DIAGNOSIS LLC

Provider Business Mailing Address
First Line	:	6108 WESTBRIDGE BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55436
Country	:	US
Telephone Number	:	320-492-7262
Fax Number	:

Provider Business Practice Location Address
First Line	:	6108 WESTBRIDGE BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55436
Country	:	US
Telephone Number	:	320-492-7262
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MR. DAVID MICAHEL WILLIAMS
Credential	:	D.O.
Telephone Number	:	320-290-2025

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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