Organization
TOTAL TRANSFORMATION CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FELISTAS MADZIWA M.D (PHYSICIAN)
(701) 500-3027
Entity
Organization
Contact information
Practice address
317 16TH ST NW, MINOT, ND 58703-2919
(701) 837-9900
Mailing address
317 16TH ST NW, MINOT, ND 58703-2919
(701) 837-9900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10461
STATE LICENSE
ND
01
—
1124006879
NPI
ND
Enumeration date
04/25/2014
Last updated
06/22/2015
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