MEDICARE: MINNESOTA NATURAL MEDICINE

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	23328	MN

General Provider Information

NPI Number	:	1417193210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNESOTA NATURAL MEDICINE

Provider Business Mailing Address
First Line	:	3640 TALMAGE CIRCLE
Second Line	:	#208
City	:	VADNAIS HTS
State	:	MN
Zip	:	55110
Country	:	US
Telephone Number	:	651-484-5567
Fax Number	:	651-484-5011

Provider Business Practice Location Address
First Line	:	3640 TALMAGE CIRCLE
Second Line	:	#208
City	:	VADNAIS HTS
State	:	MN
Zip	:	55110
Country	:	US
Telephone Number	:	651-484-5567
Fax Number	:	651-484-5011

Authorized Official
Title or Position	:	OFFICE MANAGER/OWNER
Name	:	JANET K FOLEY
Credential	:
Telephone Number	:	651-484-5567

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/29/2008

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Directions to “MINNESOTA NATURAL MEDICINE ” Practice Location

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