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1881387504

NPI Code Detail

MEDICARE: YOURPATH CARE, PLLC

MEDICARE: YOURPATH CARE, PLLC

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	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician
3	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
4	2084P0804X	Child & Adolescent Psychiatry Physician
5	363L00000X	Nurse Practitioner
6	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881387504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOURPATH CARE, PLLC

Provider Business Mailing Address
First Line	:	700 RAYMOND AVE STE 130
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1778
Country	:	US
Telephone Number	:	612-895-1510
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 RAYMOND AVE STE 130
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1778
Country	:	US
Telephone Number	:	612-895-1510
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN MICHAEL DELISI
Credential	:	MD
Telephone Number	:	612-699-7778

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/30/2023

Similar Medicare Providers

1528063765 — STEPHEN M DELISI MD
Practice Location Address:

700 RAYMOND AVE STE 130
SAINT PAUL, MN
55114-1778

Practice Phone: 612-699-7778
Practice Fax:

1205020005 — MELISSA M. J. BAUMGART APRN-BC
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700 RAYMOND AVE STE 130
SAINT PAUL, MN
55114-1778

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1093451361 — YOUR PATH, LLC
Practice Location Address:

700 RAYMOND AVE STE 130
SAINT PAUL, MN
55114-1778

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Practice Fax:

1174200356 — DR. NATHAN WILLIAM KORANDA DNP
Practice Location Address:

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Directions to “YOURPATH CARE, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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