| Diamond Lake Clinic, P.c. | |
|
5939 Portland Ave Minneapolis MN 55417-3127 | |
| (612) 806-3011 | |
| Not Available |
| Full Name | Diamond Lake Clinic, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5939 Portland Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Chukwuemeka Alexander Anyake (PHYSICIAN) |
| Authorized Official Contact | 6128063011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond Lake Clinic, P.c. 5939 Portland Ave Minneapolis MN 55417-3127 Ph: (612) 806-3011 | Diamond Lake Clinic, P.c. 5939 Portland Ave Minneapolis MN 55417-3127 Ph: (612) 806-3011 |
| NPI Number | 1740669498 |
|---|---|
| Provider Enumeration Date | 05/27/2015 |
| Last Update Date | 04/01/2025 |
| Certification Date | 04/01/2025 |
| Medicare PECOS PAC ID | 8022324664 |
|---|---|
| Medicare Enrollment ID | O20150827002511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740669498 | NPI | - | NPPES |
| Provider Name | Christine G Lewis |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1750430286 PECOS PAC ID: 2062438542 Enrollment ID: I20051024000713 |
| Provider Name | Chukwuemeka A Anyake |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144495185 PECOS PAC ID: 9234307851 Enrollment ID: I20110725000766 |
| Provider Name | Felicia V Ikebude |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275957771 PECOS PAC ID: 3870725146 Enrollment ID: I20140421001257 |
| Provider Name | Ronald J Zuchora Walske |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518140391 PECOS PAC ID: 0042585457 Enrollment ID: I20171011002688 |
| Provider Name | Rachel A Sumo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841787470 PECOS PAC ID: 9830454891 Enrollment ID: I20180523001414 |
| Provider Name | Jennifer A Brummer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356088991 PECOS PAC ID: 7719354315 Enrollment ID: I20221111000903 |
| Provider Name | Mirabel Mambo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639888092 PECOS PAC ID: 6800243478 Enrollment ID: I20231103003202 |
| Provider Name | Abena Viola Prempeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538844345 PECOS PAC ID: 3072050806 Enrollment ID: I20240730000827 |
| Provider Name | Esther Achie Njingu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588347181 PECOS PAC ID: 4587101902 Enrollment ID: I20240802002964 |
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