| Sharon R Koukkari Llc | |
|
5354 Parkdale Dr Suite 300 St Louis Pk MN 55416-1603 | |
| (512) 889-1692 | |
| (952) 546-1445 |
| Full Name | Sharon R Koukkari Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5354 Parkdale Dr, St Louis Pk, Minnesota |
| Authorized Official Name and Position | Sharon R Koukkari (PRESIDENT) |
| Authorized Official Contact | 6128891692 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sharon R Koukkari Llc 19320 81st Pl N Maple Grove MN 55311-1625 Ph: (612) 889-1692 | Sharon R Koukkari Llc 5354 Parkdale Dr Suite 300 St Louis Pk MN 55416-1603 Ph: (512) 889-1692 |
| NPI Number | 1306170741 |
|---|---|
| Provider Enumeration Date | 10/01/2009 |
| Last Update Date | 10/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306170741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LP1444 (Minnesota) | Primary |