| Doctors at Home PC | |
|
12600 Whitewater Dr Ste 125 Minnetonka MN 55343-4602 | |
| (952) 562-1235 | |
| Not Available |
| Full Name | Doctors at Home PC |
|---|---|
| Speciality | Family Medicine |
| Location | 12600 Whitewater Dr Ste 125, Minnetonka, Minnesota |
| Authorized Official Name and Position | Dana Maxwell Shipp (MD) |
| Authorized Official Contact | 7605255635 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctors at Home PC 12600 Whitewater Dr Ste 125 Minnetonka MN 55343-4602 Ph: (952) 562-1235 | Doctors at Home PC 12600 Whitewater Dr Ste 125 Minnetonka MN 55343-4602 Ph: (952) 562-1235 |
| NPI Number | 1841043296 |
|---|---|
| Provider Enumeration Date | 04/08/2024 |
| Last Update Date | 05/02/2024 |
| Certification Date | 05/02/2024 |
| Medicare PECOS PAC ID | 8426490954 |
|---|---|
| Medicare Enrollment ID | O20240529001713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841043296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Leslie Glen Massoglia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992780712 PECOS PAC ID: 1254379159 Enrollment ID: I20050421000224 |
| Provider Name | Mekeesha Mcclure |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053517946 PECOS PAC ID: 0749347987 Enrollment ID: I20200819002942 |
| Provider Name | Athnasia Klocke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427540707 PECOS PAC ID: 1254874068 Enrollment ID: I20240621001301 |
| Provider Name | Kristin B Cole |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1417716705 PECOS PAC ID: 9234673708 Enrollment ID: I20240626001528 |
| Provider Name | Constance Daramola |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538768700 PECOS PAC ID: 0648718908 Enrollment ID: I20240816003832 |
| Provider Name | Emily Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508124264 PECOS PAC ID: 4183867088 Enrollment ID: I20250314001235 |
| Provider Name | Emily Adams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700696721 PECOS PAC ID: 8325566375 Enrollment ID: I20250514001397 |
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