Organization
SOUTHDALE MEDICAL PARTNERS CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL PAUL BRANDT (ADMINISTRATOR)
(612) 961-4322
Entity
Organization
Contact information
Practice address
902 INWOOD AVE N STE 902, OAKDALE, MN 55128-6625
(952) 999-4049
Mailing address
902 INWOOD AVE N, SAINT PAUL, MN 55128-6625
(651) 815-6880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/01/2021
Last updated
05/03/2023
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