Organization
ADVACARE MEDICAL CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MAKONDE OGATO CNP (PRACTICE MANAGER)
(651) 354-6602
Entity
Organization
Contact information
Practice address
5325 W 74TH ST STE 9, EDINA, MN 55439-2212
(651) 354-6602
Mailing address
1359 KNOLL DR, SHAKOPEE, MN 55379-4624
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QG0250X
Genetics Clinic/Center
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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