Organization
TOTAL HEALTHCARE AND PHYSICAL MEDICINE PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KOULA VANG (OFFICE MANAGER)
(651) 636-5560
Entity
Organization
Contact information
Practice address
2151 HAMLINE AVE N, STE. 111, ROSEVILLE, MN 55113-4236
(651) 636-5560
(651) 636-4406
Mailing address
2151 HAMLINE AVE N, STE. 111, ROSEVILLE, MN 55113-4236
(651) 636-5560
(651) 636-4406
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
30851
MN
363L00000X
Nurse Practitioner
13954
MN
Other
Enumeration date
01/12/2011
Last updated
02/03/2011
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