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Organization
MEDICAL ADDICTION TREATMENT CLINIC
Active
Organization
MEDICAL ADDICTION TREATMENT CLINIC
Active
Other names
Sage Prairie
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNE M PYLKAS MD (CEO)
(612) 435-7380
Entity
Organization
Contact information
Practice address
3805 WASHINGTON AVE N, MINNEAPOLIS, MN 55412-2141
(612) 887-6282
(612) 437-4992
Mailing address
3805 WASHINGTON AVE N, MINNEAPOLIS, MN 55412-2141
(612) 887-6282
(612) 437-4992
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
52519
MN
261Q00000X
Clinic/Center
—
NULL
363AM0700X
Medical Physician Assistant
12684
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
12/13/2012
Last updated
08/17/2022
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