MEDICARE: MINNHEALTH FAMILY PHYSICIANS, 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	207Q00000X	Family Medicine Physician	1124	MN

General Provider Information

NPI Number	:	1598982605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNHEALTH FAMILY PHYSICIANS, P.A.

Provider Business Mailing Address
First Line	:	2025 SLOAN PL
Second Line	:	SUITE 35
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2007
Country	:	US
Telephone Number	:	651-772-2262
Fax Number	:	651-772-1889

Provider Business Practice Location Address
First Line	:	1814 N SAINT PAUL RD
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-4700
Country	:	US
Telephone Number	:	651-777-8393
Fax Number	:	651-770-1375

Authorized Official
Title or Position	:	MINNHEALTH PRESIDENT
Name	:	KEITH A OELSCHLAGER
Credential	:	M.D.
Telephone Number	:	651-766-0520

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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