| Park Nicollet | |
|
9555 Upland Ln N Maple Grove MN 66369 | |
| (952) 993-1589 | |
| Not Available |
| Full Name | Park Nicollet |
|---|---|
| Speciality | Clinic/center |
| Location | 9555 Upland Ln N, Maple Grove, Minnesota |
| Authorized Official Name and Position | Sofiya Tsukerman (HTCP) |
| Authorized Official Contact | 7634944686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Nicollet 7102 Olive Lane North Maple Grove MN 55311 Ph: () - | Park Nicollet 9555 Upland Ln N Maple Grove MN 66369 Ph: (952) 993-1589 |
| NPI Number | 1982150728 |
|---|---|
| Provider Enumeration Date | 08/31/2016 |
| Last Update Date | 08/31/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982150728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | L 48617-4 (Minnesota) | Primary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | L 48617-4 (Minnesota) | Secondary |
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