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Organization
CENTER FOR PRIMARY CARE AND REHABILITATION, PA
Active
Organization
CENTER FOR PRIMARY CARE AND REHABILITATION, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELENA LEV POLUKHIN MD, PHD (OWNER/MEDICAL DIRECTOR)
(651) 789-8022
Entity
Organization
Contact information
Practice address
880 BLUE GENTIAN RD STE 165, EAGAN, MN 55121-1772
(651) 789-8022
(651) 789-8028
Mailing address
3006 FRANK ST, MAPLEWOOD, MN 55109-5501
(651) 789-8022
(651) 789-8028
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
45600
MN
Other
Enumeration date
08/12/2011
Last updated
08/12/2011
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