Organization
AMERICAN INDIAN COMMUNITY DEVELOPMENT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL P HAAG (DIRECTOR)
(612) 813-1610
Entity
Organization
Contact information
Practice address
1600 EAST 19TH STREET, MINNEAPOLIS, MN 55404
(612) 874-1048
(612) 813-1612
Mailing address
1404 E FRANKLIN AVE, MINNEAPOLIS, MN 55404-2134
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200020115141
ORGANIZATION PROVIDER #
MN
Enumeration date
03/29/2007
Last updated
04/08/2008
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