Organization
CHILD AND TEEN MEDICAL CENTER
Active
Other names
Fridley Children's and Teenagers' Medical Center PA
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA MARIE BENNETT BA (PRACTIC ADMINISTRATOR)
(763) 333-7755
Entity
Organization
Contact information
Practice address
11107 ULYSSES ST NE STE 100, BLAINE, MN 55434-4184
(763) 333-7733
(763) 333-7711
Mailing address
11107 ULYSSES ST NE STE 100, BLAINE, MN 55434-4184
(763) 333-7733
(763) 333-7711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Enumeration date
03/30/2007
Last updated
08/24/2021
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