Organization
MIND BODY MEDICINE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY G. KOHLS M.D. (OWNER)
(218) 628-2130
Entity
Organization
Contact information
Practice address
8 N 2ND AVE E, SUITE 209, DULUTH, MN 55802-2102
(218) 628-2130
Mailing address
8 N 2ND AVE E, SUITE 209, DULUTH, MN 55802-2102
(218) 628-2130
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40M27KO
BLUE CROSS
MN
Enumeration date
02/05/2008
Last updated
02/05/2008
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