Basic Information
| Provider Information | |||||||||
| NPI: | 1285816975 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALISTS IN INTERNAL MEDICINE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 E 28TH ST | ||||||||
| Address2: | SUITE 740 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128707711 | ||||||||
| FaxNumber: | 6128701666 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 E 28TH ST | ||||||||
| Address2: | SUITE 740 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128707711 | ||||||||
| FaxNumber: | 6128701666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2007 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCLINN | ||||||||
| AuthorizedOfficialFirstName: | DUDLEY | ||||||||
| AuthorizedOfficialMiddleName: | MAURICE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6128707711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 949 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.