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Physicians Preventive Medicine Preventive Medicine/Occupational Environmental Medicine

Provider NPI: 1821074337

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 952-541-2500  Fax: 952-595-6455

Business Mailing Address:
8170 33RD AVE S MS21110Q MINNEAPOLIS, MN 55425-4516 US
Tel: 952-883-5375  Fax: 952-595-6455

NPI Information:
NPI: 1821074337
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Preventive Medicine
Preventive Medicine/Occupational Environmental Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 2083P0500X





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