Basic Information
| Provider Information | |||||||||
| NPI: | 1659464162 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REALIEF MEDICAL, P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REALIEF MEDICAL, P.A. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 HIGHWAY 100 S | ||||||||
| Address2: | SUITE 229 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554161529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524566160 | ||||||||
| FaxNumber: | 9528359830 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 HIGHWAY 100 S | ||||||||
| Address2: | SUITE 229 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554161529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524566160 | ||||||||
| FaxNumber: | 9528359830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | ALFRED | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 9524566160 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | M.D., D.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 24538 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1396838850 | 01 | MN | NPI | OTHER | 1508102500 | 01 | GROUP NPI | OTHER | C09271 | 01 | GROUP MEDICARE NUMBER | OTHER |