MEDICARE: MINNESOTA BROTHERS INC

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	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3967699-2	OTHER	MN	SOS CORP CHARTER # MN

General Provider Information

NPI Number	:	1386952976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNESOTA BROTHERS INC

Provider Business Mailing Address
First Line	:	5430 VILLAGE CREEK PKWY
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443
Country	:	US
Telephone Number	:	952-484-1322
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 VILLAGE CREEK PKWY N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3153
Country	:	US
Telephone Number	:	952-484-1322
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ABDALLA DHUNKAL
Credential	:	MR.
Telephone Number	:	612-414-7739

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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Directions to “MINNESOTA BROTHERS INC ” Practice Location

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