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Organization
INTEGRATED MED GROUP PLLC
Active
Organization
INTEGRATED MED GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON STADTHER DC (CEO/OWNER)
(763) 515-8799
Entity
Organization
Contact information
Practice address
2781 FREEWAY BLVD STE 160, BROOKLYN CENTER, MN 55430-1765
(763) 515-8799
(763) 244-8021
Mailing address
2781 FREEWAY BLVD STE 160, BROOKLYN CENTER, MN 55430-1765
(763) 515-8799
(763) 244-8021
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/09/2020
Last updated
10/09/2020
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