Organization
EDDICTION MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORI MYER (OFFICE STAFF)
(612) 393-1212
Entity
Organization
Contact information
Practice address
12018 285TH STREET, LINDSTROM, MN 55045
(612) 393-1212
(651) 400-3892
Mailing address
PO BOX 833, LINDSTROM, MN 55045-0833
(612) 393-1212
(651) 257-9422
Taxonomy
Speciality
Code
Description
License number
State
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932488608
—
MN
Enumeration date
10/09/2020
Last updated
05/04/2021
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