| Housecallmn | |
|
1714 Howard St N Maplewood MN 55109-4842 | |
| (612) 509-5522 | |
| (651) 414-0279 |
| Full Name | Housecallmn |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1714 Howard St N, Maplewood, Minnesota |
| Authorized Official Name and Position | Rachel Polski (OFFICE MANAGER) |
| Authorized Official Contact | 6514448512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Housecallmn 855 Village Center Dr Ste 181 North Oaks MN 55127-3016 Ph: (651) 444-8512 | Housecallmn 1714 Howard St N Maplewood MN 55109-4842 Ph: (612) 509-5522 |
| NPI Number | 1255573358 |
|---|---|
| Provider Enumeration Date | 04/03/2009 |
| Last Update Date | 03/29/2021 |
| Certification Date | 02/16/2021 |
| Medicare PECOS PAC ID | 1254480882 |
|---|---|
| Medicare Enrollment ID | O20090601000202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255573358 | NPI | - | NPPES |
| 903318100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Robert J Sevenich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801856307 PECOS PAC ID: 5395789150 Enrollment ID: I20050614000188 |
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