Medical Addiction Treatment Clinic
Internal Medicine, Addiction Medicine in Minneapolis, MN. Organization (NPI-2).
NPI number1891031209
StatusActive
Last updated in NPPESAug 17, 2022
Details
- NPI
- 1891031209
- Entity type
- Organization (NPI-2)
- Legal business name
- Medical Addiction Treatment Clinic
- Organization subpart
- No
- Enumeration date
- Dec 13, 2012
- Certification date
- Aug 17, 2022
- Last updated
- Aug 17, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RA0401X | Internal Medicine, Addiction Medicine | 52519 | MN | Yes |
| 261Q00000X | Clinic/Center | – | – | |
| 363AM0700X | Physician Assistant, Medical | 12684 | MN | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – |
Other names
- Sage Prairie (Doing Business As)
Practice location
3805 Washington Ave NMinneapolis, MN 55412-2141
Phone 612-887-6282 · Fax 612-437-4992
Mailing address
3805 Washington Ave NMinneapolis, MN 55412-2141
Phone 612-887-6282 · Fax 612-437-4992
Authorized official
Anne M Pylkas
Ceo
6124357380
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Addiction Medicine (Internal Medicine) Physician providers in Minneapolis, MN
- Gavin B Bart, MDNPI 1508803610
- Milton L Bullock, MDNPI 1639116924
- Brian John Grahan, MDNPI 1770809873
- Mitika KanabarNPI 1154616324
- Pathway To Recovery LLCNPI 1205683570
- Charles P Reznikoff, MDNPI 1013952175
- John Richard Stroemer, M.D.NPI 1659394815
All 8 Addiction Medicine (Internal Medicine) Physician providers in Minneapolis · All 27,202 providers in Minneapolis
Checking a whole list?
Paste up to 5,000 NPIs and download status, name, taxonomy, license and address for each one. Useful for credentialing, billing and pharmacy claim checks.