# MINOR MEDICAL SQUAD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821646985
- **Authorized official:** MR. MICHAEL VITO DIMUCCI FNP-C (OWNER, FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (612) 805-8676

## Contact information

- **Practice address:** 5775 WAYZATA BLVD STE 700, ST LOUIS PARK, MN 55416-1233
- **Practice address phone:** (612) 504-6160
- **Practice address fax:** (855) 818-2050
- **Mailing address:** 826 TRENTON LN N, PLYMOUTH, MN 55441-4496
- **Mailing address phone:** (612) 805-8676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/30/2019
- **Last updated:** 09/11/2025