MEDICARE: ALLINA HEALTH SYSTEM

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1770034670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLINA HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:	MAIL ROUTE 10585
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55440-0043
Country	:	US
Telephone Number	:	612-262-1166
Fax Number	:	612-262-4258

Provider Business Practice Location Address
First Line	:	11850 BLACKFOOT ST NW STE 405
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2773
Country	:	US
Telephone Number	:	763-236-0888
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DOMINICA TALLARICO
Credential	:
Telephone Number	:	612-222-2222

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	02/25/2025

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