# MEDICAL ADDICTION TREATMENT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sage Prairie
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891031209
- **Authorized official:** DR. ANNE M PYLKAS MD (CEO)
- **Authorized official phone:** (612) 435-7380

## Contact information

- **Practice address:** 3805 WASHINGTON AVE N, MINNEAPOLIS, MN 55412-2141
- **Practice address phone:** (612) 887-6282
- **Practice address fax:** (612) 437-4992
- **Mailing address:** 3805 WASHINGTON AVE N, MINNEAPOLIS, MN 55412-2141
- **Mailing address phone:** (612) 887-6282
- **Mailing address fax:** (612) 437-4992

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | 52519 | MN | Yes |
| 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